Which medications have been shown to decrease mortality in chronic heart failure with systolic dysfunction?

The choice of medications that decrease mortality in chronic heart failure with systolic dysfunction includes ACE inhibitors, cardioselective beta blockers, and aldosterone antagonists.

ACE inhibitors are pivotal in managing heart failure as they reduce afterload and preload, improve cardiac output, and have been shown in multiple studies to decrease mortality risk. They also help mitigate the detrimental neurohormonal activation that occurs in heart failure.

Cardioselective beta blockers, such as metoprolol succinate and carvedilol, have been shown in clinical trials to improve survival rates. They provide protective effects on the heart by reducing heart rate, improving left ventricular function, and decreasing the progression of heart failure.

Aldosterone antagonists like spironolactone or eplerenone are important as they contribute to mortality reduction by counteracting the harmful effects of aldosterone and preventing fibrosis and remodeling of cardiac tissue. Studies demonstrate that these agents significantly lower mortality in patients with advanced systolic heart failure.

Other choices listed involve medications that play roles in symptomatic relief, like loop diuretics (which manage fluid overload) and inotropic agents (which can temporarily improve heart function), but they do not demonstrate a mortality benefit. Calcium channel blockers and thiazide diuretics