Advances in the treatment of congestive heart failure: new approaches for an old disease.

Heart failure is a symptom complex of varied etiology associated with substantial mortality. Approximately 5 million Americans have the disease, with 400,000 new cases diagnosed each year. Despite better understanding of its pathophysiology, therapeutic options remain suboptimal and the syndrome remains associated with high rates of hospitalization and loss of economic productivity. Management traditionally included vasodilators, diuretics, and digoxin, with a focus on controlling symptoms and improving ejection fraction and exercise capacity. Drug therapy now is focused on improving survival, with a reduction in health care costs related to hospitalizations. Drugs with a proven benefit in reducing morbidity and mortality are angiotensin-converting enzyme inhibitors, beta-blockers, and the combination of hydralazine plus a nitrate. Diuretics, digoxin, dihydropyridine calcium channel blockers, phosphodiesterase inhibitors, catecholamine infusions, amiodarone, left ventricular assist devices, and transplantation are also options.

Medication use evaluation: a work in progress.

The medication use evaluation (MUE) Program at the University of Iowa Hospitals and Clinics (UIHC) is a dynamic program that is constantly changing to meet the needs of this tertiary care institution. This article will provide an overview of the MUE process at UIHC as well as provide an example of a long-standing initiative that has evolved significantly since its inception in 1993. Examples of four other initiatives also will be provided to demonstrate the scope of this program. The examples to be covered in this article include: 5-HT3 receptor antagonists, alteplase, automatic substitution of cefotaxime, proton pump inhibitors, and COX-2 selective agents.