Turning to Drugs for Heart Failure
While there have been setbacks in recent research, drugs remain the most common effective heart-failure treatment.
Aggressive Heart-Failure Treatment
Experts are consistently stressing the importance of treating heart failure aggressively.
If you look at the heart-failure trials over the last 15 years, combining ACE inhibitors, and beta-blockers with devices used in heart-failure treatment, the rate of death has dropped 68%, says Bristow. "That's spectacular progress."
"But that's only progress in clinical trials," Bristow tells WebMD. "The problem is that these effective treatments are not getting out to the community. There continue to be only about 50% to 60% of patients who should be on ACE inhibitors who are actually on them, and 30% to 40% of the people who should be using beta-blockers who are actually are."
Part of the problem is that beta-blockers can cause side effects and getting the right dosage can be difficult. As a result, doctors may be reluctant to prescribe them.
"Side effects can be problematic with beta-blockers since they can actually make you feel worse," says Susan Bennett, RN, DNS, an Indiana University nursing school professor.
Still, experts generally agree that heart-failure treatment has become more aggressive in recent years as the message has gotten to physicians. "Sure, there's always room for improvement," says Konstam. "But I see positive trends in the speed with which clinicians respond to new treatment information."
The Bulging Medicine Cabinet
A potential problem with the success of drugs for heart-failure treatment is that it means the number of drugs that people are taking has increased. When new drugs are developed, they are typically not compared in head-to-head studies with old drugs. As a result, old drugs don't get replaced; instead, the new drugs are often added to existing heart-failure treatment. This can add up to a lot of pills to swallow. The greater the number of pills, of course, the harder it becomes to stick to a drug regimen.
"This can be a real problem," says Bennett. "A lot of these patients are elderly, they don't feel well, and they may not be able to see well. Following a complicated drug regimen can be hard for them."
"We're facing an era when patients are going to be taking multiple drugs and perhaps even have devices too," Cohn tells WebMD. "We're making therapy very complicated."
But while Pitt agrees that additional medicines may complicate heart-failure treatment, he feels that complexity is the cost of progress. "If I can show you that I'm adding a benefit to [death and sickness] with another drug, I'm not going to apologize for that," he says. He also observes that drug cocktails have become common in the treatment of other diseases, such as cancer.
Hitting the Wall?
Drug research has had some setbacks in recent years. "One of the things that's clearly happened in the last few years is that we hit the wall with drug therapy," says Bristow. "The last six or so trials of promising drugs have been negative."