How Should Diastolic Heart Failure Be Treated?
As might be expected, definitive trials of the treatment of diastolic HF are lacking; what studies have been done have been either inconclusive or small.[22,23] The Digoxin Investigation Group study[24] of the effects of digoxin on outcomes in HF included a subgroup of 492 patients with normal EFs, but found no effect of digoxin compared with placebo on mortality or hospitalizations for HF. The AHA/ACC statement (cited above) on the treatment of HF has no specific recommendations for treating diastolic HF and just makes general suggestions such as treating the hypertension, controlling atrial rate if atrial fibrillation is present, and using diuretics if there is venous congestion.[5] The only large-scale outcome study to date (published after the AHA/ACC statement) is the Candesartan in Heart-Assessment of Reduction in Mortality and Morbidity (CHARM)-Preserved trial,[25] in which 3023 patients with HF and normal EFs were randomized to have either candesartan or placebo added to their
