Scompenso cardiaco cronico e morte improvvisa: Il messaggio del CIBIS III

The heart failure is one of the pathologies with major social and economic impact in the western world. The neurohormonal modulation is the only effective pharmacological approach. The increasing use of implantable devices apparently sets against the possibilities of implementing in the patient's treatment scheme. However, the anti-adrenergic therapy, once used at optimal dose, is highly effective on sudden death and on rates of implantable cardioverter defibrillators discharges. CIBIS-III proposes the beta-blocker use as primary approach, even prior to ACE inhibitors. This might be specifically true in the patient whit evidence of autonomic imbalance resulting in sympathetic hyperactivity. CIBIS-III shows that bisoprolol can be used in chronic heart failure patients also in absence of the concomitant enalapril therapy. Using bisoprolol as primary approach allows to reach optimal doses more effective on arrhythmic risk. CIBIS III results propose new strategies to the current international heart failure guidelines's recommendations.