<P> In people with markedly reduced ejection fraction, the use of an aldosterone antagonist, in addition to beta blockers and ACE - I, can improve symptoms and reduce mortality . </P> <P> Second - line medications for CHF do not confer a mortality benefit . Digoxin is one such medication . Its narrow therapeutic window, a high degree of toxicity, and the failure of multiple trials to show a mortality benefit have reduced its role in clinical practice . It is now used in only a small number of people with refractory symptoms, who are in atrial fibrillation and / or who have chronic low blood pressure . </P> <P> Diuretics have been a mainstay of treatment for treatment of fluid accumulation, and include diuretics classes such as loop diuretics, thiazide - like diuretic, and potassium - sparing diuretic . Although widely used, evidence on their efficacy and safety is limited, with the exception of mineralocorticoid antagonists such as spironolactone . Mineralocorticoid antagonists in those under 75 years old appear to decrease the risk of death . A recent Cochrane review found that in small studies, the use of diuretics appeared to have improved mortality in individuals with heart failure . However, the extent to which these results can be extrapolated to a general population is unclear due to the small number of participants in the cited studies . </P> <P> Anemia is an independent factor in mortality in people with chronic heart failure . The treatment of anemia significantly improves quality of life for those with heart failure, often with a reduction in severity of the NYHA classification, and also improves mortality rates . The latest European guidelines (2012) recommend screening for iron - deficient anemia and treating with parenteral iron if anemia is found . </P>

Discuss the compensatory mechanisms of congestive heart failure