Turning to Drugs for Heart Failure
While there have been setbacks in recent research, drugs remain the most common effective heart-failure treatment.
Hitting the Wall? continued...
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."
The Future of Drug Treatment
But the significance of these failures is the subject of some debate among heart-failure experts.
"I think our vision is very short," says Pitt. "A lot of people ... were saying that we had exhausted the potential of neurohormonal blockade and that ACE inhibitors and beta-blockers were as good as we could get. That wasn't true."
Pitt sees potential in other drugs used to affect hormonal levels, including statins, which are used to treat high cholesterol. Some of the hormonal drugs that have had disappointing results in trials are also being studied further.
Other drug studies are focusing on the possibilities of more effectively treating diastolic dysfunction, which is often overshadowed by the more common systolic dysfunction. Researchers and doctors have only recently begun to truly understand diastolic dysfunction -- which occurs when the heart loses its ability to relax and fill with blood.
"There are a number of approaches that are in the early stages of testing and we're just going to have to wait and see," Pitt says. "But I suspect that over the next few years, we're going to find more and more effective drugs."
And despite the setbacks, there is still great reason to be optimistic about the effectiveness of drugs in heart-failure treatment.
"If you look at the big picture in the last 12 years, we've made enormous progress in treating heart failure," says Konstam. "Back then, we didn't really know if we could improve the outcome of the disease. Today, I have many patients in my practice who -- while they're not cured -- are cured from a functional perspective. We couldn't even imagine that not too many years ago."
Originally published May 2003.
Medically updated Sept. 30, 2004.