Turning to Drugs for Heart Failure
While there have been setbacks in recent research, drugs remain the most common effective heart-failure treatment.
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."
Konstam agrees. We've had some disappointments in recent years from some drugs that held a lot of promise in heart-failure treatment, he says.
Although the synthetic hormone Natrecor -- which mimics the effects of natriuretic peptide, a hormone that dilates the blood vessels -- has received some attention, its usefulness is unclear.
"I don't think that Natrecor represents a breakthrough in management," says Cohn. "I know many physicians who don't quite see why it's any better than the traditional, less expensive drugs that we currently have that do the same thing." For now, Natrecor is only administered intravenously in the hospital.
Drugs have been so successful in heart-failure treatment that some experts worry that attempts to improve it much more will be tricky. "I think that the development of ACE inhibitors and ARBs and beta-blockers, when they're used and combined, that we've reduced the risk of death dramatically," says Cohn. "I think attempts to lower it further are going to be difficult."