What is the role of revascularisation in ischaemic heart failure?

Although ischaemic heart disease is the most common cause of heart failure in the developed world, optimal treatment remains unclear. Medical treatment remains limited in its effectiveness with persistently high mortality and morbidity rates, and transplantation is an option available to very few. Revascularisation aimed at improving left ventricular function rather than relief of angina is a promising option that should be properly tested. A prospective randomised study comparing revascularisation with optimal medical treatment in patients with ischaemic heart failure but viable myocardium is required. Until the results of such a study become available cardiologists wishing to consider revascularisation for their heart failure patients might consider the algorithm (fig 1).