Book Review

Congestive Cardiac Failure: Pathophysiology and Treatment

N Engl J Med 1994; 330:944-945March 31, 1994

Article

Congestive Cardiac Failure: Pathophysiology and Treatment
Edited by David B. Barnett, Hubert Pouleur, and Gary S. Francis. 383 pp. New York, Marcel Dekker, 1993. $135. ISBN: 0-8247-8821-4

A little more than a decade ago, a workshop on advanced congestive heart failure was held at the National Institutes of Health. At that time, the armamentarium for treating heart failure was limited. However, there appeared to be a consensus favoring the use of diuretics and digoxin, and theoretical evidence supported the use of other agents, including vasodilators and angiotensin-converting-enzyme inhibitors. Indeed, in 1982, only 12 centers were performing cardiac transplantation, with a three-year mortality of nearly 50 percent. That the past decade has been associated with an explosion of new and novel therapies for heart failure is clear from a perusal of this comprehensive book, which reviews the current epidemiologic and pathophysiologic features and treatment of this important disease.

The 17 chapters are written by recognized experts, resulting in a current and authoritative work. Although multiauthored, the book flows evenly from one chapter to the next, and the style is easy to read. The chapters are directed to the practitioner, but each chapter is exhaustively referenced, providing an important reference source for investigators pursuing research in heart failure. The illustrations are appropriate in number, emphasize important points, and enhance the text. Furthermore, the authors have revised the text to include recent clinical results whenever possible.

Two introductory chapters review the demographic and epidemiologic aspects of heart failure, including information relevant to health care financing. Three chapters on the pathophysiologic features of heart failure provide sufficiently detailed information about the role of the adrenergic nervous system, the neurohumoral system, and ventricular remodeling. The one disappointment in the book is the lack of recent information about the molecular and biochemical pathophysiology of heart failure. However, this information is available in recent books devoted to the basic-science aspects of congestive heart failure.

The chapters on the pharmacologic treatment of heart failure are the strength of the book, well written and instructive. Although the authors espouse their own philosophies on the pharmacologic management of congestive heart failure, controversial areas are clearly delineated and disparate views are presented. An introductory chapter provides useful insight on assessing the efficacy of therapeutic agents in heart failure. An overview of transplantation reviews the selection of patients and common problems after transplantation, and a chapter on sudden death and arrhythmias succinctly reviews the mechanisms of arrhythmias in heart failure and their management.

This textbook provides up-to-date information about the pathophysiologic features and treatment of heart failure. Because it presents a balanced and rational approach in a well-organized and readable framework, it is a valuable resource for students, clinicians, and investigators, interested in the care of patients with congestive heart failure.

Arthur M. Feldman, M.D., Ph.D.
University of Pittsburgh Medical Center, Pittsburgh, PA 15261