Introduction:The management of chronic heart failure is a complex process that can involve a large number of pharmacological and non-pharmacological approaches to management (Figure 1). Guidance on drug use is provided by guidelines at the international level (such as those from the European Society of Cardiology and the joint American Heart Association/American College of Cardiology initiative) and the national level (for example, the National Institute of Clinical Excellence, the Scottish Intercollegiate Guidelines Network,16 and the Scottish Intercollegiate Group), with directions on implementation at the local or hospital level (such as regional planning groups and hospital drug formularies).This review will focus on three controversial aspects of the management of chronic heart failure: diagnosis, dose and sequence, and polypharmacy.
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