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The Consensus Recommendations for the Management of Chronic Heart Failure include:
- Maintenance of fluid balance by salt restriction and daily monitoring of body weight.
- Control of atrial fibrillation, anticoagulation in high-risk patients, and revascularization in selected patients.
- Avoidance of antiarrhythmic drugs, nonsteroidal anti-inflammatory drugs, and most calcium channel blockers.
- Measurement of body weight is the best way of monitoring when to initiate and/or titrate a diuretic regimen. Proper dosing of a diuretic is extremely important in patients with heart failure. Underdosing with a diuretic reduces the efficacy of ACE inhibitors and increases the risks associated with use of beta-blockers.
- Treatment with ACE inhibitors and beta-blockers should not be delayed until symptoms are severe or resistant to other drugs. Alleviation of symptoms may be delayed, and disease progression may be modified, even if no symptomatic improvement occurs.
- Early side effects must not prevent long-term use of ACE inhibitors and beta-blockers.
- The consensus recommendations favor up-titration of ACE inhibitors and beta-blockers to the target doses used in clinical trials.