Risks and benefits of a multidrug approach to mild-to-moderate heart failure

Multidrug therapy offers several advantages in the management of mild-to-moderate heart failure. Treatment with a combination of agents, such as diuretics, digoxin, angiotensin-converting enzyme inhibitors, and β blockers, can provide relief of symptoms while also addressing specific pathophysiologic factors. By allowing therapy to be tailored to the individual, the multidrug approach can slow progression of the disease, reduce or prevent the need for hospitalization, and decrease health-care costs. Evidence of the benefit of the multidrug approach has come from numerous trials in which newer treatments for heart failure have been evaluated in the context of the background therapy considered standard at the time of the trial. Compliance may be a challenge with multidrug therapy, particularly for patients who generally feel well and do not experience symptoms that interfere with normal daily function. The clinician must ensure that patients understand the need to comply with the prescribed regimen to prevent more serious problems in the future. Multidrug therapy may also require that patients be more closely monitored so that dosages of the individual medications can be adjusted to provide maximum benefit with a minimum of side effects.