[Experience and prospects in the treatment of heart failure]. / Acquis et perspectives dans le traitement de l'insuffisance cardiaque.

Epidemiological studies have pointed out the continuous and significant increase of heart failure prevalence as well as the change of the patients profile in relation to therapeutic and technological improvement in the treatment of cardiovascular diseases. A new entity has thus been identified especially among the elderly: heart failure with preserved ejection fraction. This pathology is still not well identified, although its clinical specifications and its prognosis have been specified, as some uncertainties concerning the disease-modifying drug remain. Concerning systolic heart failure, progress in pharmacological treatments and in medical devices has lead to a decrease in sudden death and to a lengthening of survival duration, while both advanced heart failure and hospitalization for acute heart failure rates are increasing. Progress in cardiac surgery, and interventional cardiology partly explains these evolutions. At the same time, pharmacological treatments such as diuretics and digitalics have been replaced by neurohormonal antagonists with an obvious impact on survival and quality of life. Size reduction and performance improvements of pace makers and defibrillators have been determining for this progress.Angiography, echography, RMN (Resonnance Magnetic Nuclear) and BNP (Brain Natriuretic Peptide) dosage have modified daily therapeutic recommendations, improved pathophysiological understanding and pointed out the major role of cardiac and vascular remodelling. Unfortunately, patients are still confronted with an initial or chronic treatment failure. Heart failure management programmes, taking into account patient observance and guidelines implementation, allows the improvement of the quality of life, survival and the decrease of the major costs related to this chronic illness. New pharmacological approaches, especially inotropic drugs(myosin activators, energetic metabolism modulators), new aquaretic and diuretic drugs and even new left ventricular assistance devices or implantable artificial heart are thus essential.