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A New Approach to Treatment of CHF in Dogs

A New Approach to Treatment of CHF in Dogs

Compliance with the American College of Veterinary Internal Medicine (ACVIM) guidelines for treatment of CHF just got easier…spironolactone and benazepril hcl are now available in a convenient, once-per-day, flavored, chewable tablet. Found to be safe and effective by the FDA, CARDALIS™ is approved for mild, moderate and severe congestive heart failure (CHF) in dogs. CARDALIS™ provides a unique solution for pet owners and veterinarians. 

In 2019, the ACVIM consensus committee published updated guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs1. The change to an endorsement of a quadruple therapy approach for CHF was a significant update to the treatment recommendations that were previously published in 2009. The previous guidelines recommended triple therapy (pimobendan, an angiotensin-converting enzyme inhibitor (ACEI) and a loop diuretic such as furosemide) for canine CHF. For the updated guidelines, the consensus panel agreed that a robust, broad-spectrum approach to suppression of the renin-angiotensin-aldosterone system (RAAS) is associated with an improved clinical outcome for the CHF patient. This includes the addition of aldosterone inhibition with spironolactone as a mineralocorticoid receptor antagonist (MRA). Quadruple therapy for CHF includes pimobendan, an ACEI, a loop diuretic and spironolactone as a MRA, not a weak, potassium sparing diuretic. 

The 2019 guidelines updated the recommendation to use spironolactone because CHF causes activation of the RAAS cascade. This activation ultimately leads to the formation of toxins, angiotensin II and aldosterone. Chronically, these toxins cause negative clinical effects including vasoconstriction, retention of sodium and water and cardiac remodeling or fibrosis. Even with the use of ACEIs (which reduce angiotensin II), aldosterone is often still present due to stimulation from non-ACE dependent pathways of angiotensin II formation and aldosterone breakthrough. 

Broad-spectrum inhibition of this deleterious system resulted in a better clinical outcome for patients on CARDALIS™ in a recently completed clinical trial (Clinical efficacy of a benazepril and spironolactone combination in dogs with congestive heart failure due to myxomatous mitral valve disease: The BESST Trial; publication date TBD)2. 

Containing a combination of spironolactone and benazepril hcl, CARDALIS™ provides half of the ACVIM quad-therapy recommendation for CHF in dogs (see FIGURE 1). 

Figure 1. A quad-therapy approach to CHF management in dogs is recommended by the ACVIM.1 Loop diuretics activate RAAS. Pimobendan has no effect on RAAS.3 ACEI and Spironolactone together allow for more complete RAAS blockade.

Because of the challenges of medicating the typical CHF patient, a convenient, chewable, palatable option is expected to provide the pet owner and mitral valve disease patient with a more pleasant medication experience, thus improving compliance. An alternative to human generics, this FDA-approved, once daily medication with proven safety and efficacy data is expected to give the practitioner peace of mind when prescribing for one of their most vulnerable (and difficult to medicate) patient populations2. 

To support the product, Ceva Animal Health, LLC is providing numerous virtual educational experiences at cardalis.com. Additionally, client communication aids and the CARDALIS™ resting respiratory rate smartphone app, offer the practitioner a variety of helpful resources.


  1. Keene, BW, Atkins, CE, Bonagura, JD, et al. ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med. 2019; 33: 1127–1140. https://doi.org/10.1111/jvim.15488
  2. Freedom of Information Summary, NADA #141-538 (July 27, 2020)
  3. Sayer, M., Atkins, C., Fujii, Y., Adams, A., DeFrancesco, T. and Keene, B. (2009), Acute Effect of Pimobendan and Furosemide on the Circulating Renin-Angiotensin-Aldosterone System in Healthy Dogs. Journal of Veterinary Internal Medicine, 23: 1003-1006. doi:10.1111/j.1939-1676.2009.0367.x

*In 2019, the ACVIM published new guidelines recommending a quadruple therapy approach for the treatment of CHF in dogs. The safety and efficacy of CARDALIS™ has not been investigated with pimobendan.

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CARDALIS™ trademark is the property of Ceva Santé Animale S.A. Full prescribing information at cardalis.com