Primary prevention of heart failure: what is the evidence?

Purpose Of Review: Heart failure is a worldwide epidemic. Aggressive treatment of patients at risk for heart failure is important. There are no trials targeting primary prevention of heart failure. However, there is trial data demonstrating that treatment of patients with atherosclerotic vascular disease, hypertension, and diabetes can prevent heart failure.

Recent Findings: Several recent trials further expand our knowledge of how to best treat high-risk patients. Treatment of hypertensive patients over age 80 with indapamide and an ACE-inhibitor if needed can significantly reduce heart failure and mortality. There is no additional benefit from the combination of an ACE-inhibitor and angiotensin receptor blocker therapy in patients with vascular disease or high-risk diabetic patients. Continued blood pressure control is necessary to maintain beneficial cardiovascular outcomes.

Summary: Identification and treatment of patients at high risk can prevent the development of heart failure and reduce heart failure hospitalization. Thiazide diuretics, ACE-inhibitors or angiotensin receptor blockers if ACE-inhibitor-intolerant are preferred first-line agents.