Drug and device therapy for patients with chronic heart failure

Untreated heart failure is a terminal illness with a poor prognosis. beta-blockers are an established therapy used to reduce morbidity and mortality. Hypotension and bradycardia often hinder optimal beta-blocker administration in patients with chronic heart failure. The efficacy of cardiac resynchronization therapy (CRT) in affecting favorable cardiac remodeling and reducing mortality in heart failure patients with electrical dyssynchrony has been demonstrated in landmark trials only in patients receiving optimal medical therapy. This paper demonstrates the favorable effects of CRT on cardiac hemodynamics facilitating uptitration of beta-blocker therapy. It highlights the synergistic relationship of the two therapies and emphasizes the importance of optimizing medical therapy before and after CRT implantation.