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Medical Therapy for Chronic Congestive Heart Failure

Roman Jaeschke, MD; and Gordon H. Guyatt, MD
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Grant Support: Supported in part by the Ontario Ministry of Health.

Requests for Reprints: Gordon H. Guyatt, MD, Department of Clinical Epidemiology and Biostatistics, McMaster University Health Sciences Centre, Room 3H7, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.

McMaster University
Hamilton, Ontario

Ann Intern Med. 1989;110(10):758-760. doi:10.7326/0003-4819-110-10-758
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This excerpt has been provided in the absence of an abstract.

Congestive heart failure remains a common final manifestation of ischemic, valvular, hypertensive, and myocardial disease. In the United States alone an estimated 400 000 persons develop congestive heart failureannually (1), and the prognosis of those with symptomatic heart failure remains very poor (1, 2). Five years ago, diuretics were used as the initial theraphy of congestive heart failure in the absence of randomized trials showing improvement in either symptoms or ultimate outcome. Vasodilators were considered a third-line drug (after diuretics and digitalis) and a number of vasodilators were possible choices. Digoxin was used as first- or second-line therapy without its


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