Heart Failure Treatments Offer New Hope
Feb. 11, 2003 -- Nearly 5 million Americans suffer from heart
failure, and their prognosis remains poor. The death rate of patients with this
condition is high, but two treatments offer the promise of a better outcome for
people with failing hearts.
Patients treated with beta-blocking drugs and those who got
specialized pacemakers had fewer heart failure deaths than patients who did not
received the treatments in two large studies reported Feb. 12 in The Journal
of the American Medical Association. The findings could have a big impact
on the way heart failure is treated, one expert says.
"I think we are entering a new era in the treatment of
patients with heart failure, and beta-blockers and implantable devices will be
integral components of therapy in the future," cardiologist Sergio L.
Pinski, MD, tells WebMD. "There is now no question that these treatments
Cardiac failure is a progressive condition that occurs when the
heart muscle can no longer pump blood efficiently though the body. The heart
enlarges to compensate and eventually weakens. Patients typically retain
fluids, have shortness of breath, and become easily fatigued.
Beta-blocking drugs have been shown to improve quality of life
and reduce deaths among patients with heart failure, but the drugs are not
widely used by primary care doctors treating patients with advanced disease.
Many are reluctant to give these patients beta-blockers because the potential
risks during the first few months of therapy are believed to outweigh the
benefits. Those risks include a lowering of blood pressure, a slowing of the
heart rate, and retention of sodium -- all of which can accelerate heart
failure and increase the risk of death. Many doctors also believe that the
benefits of this therapy are delayed.
But in a study that included 2,289 patients with severe heart
failure being treated in 21 countries, the risk of death over a 10-month period
was reduced by 35% among patients who took the beta-blocker drug carvedilol
compared with those who received placebo treatment.
During the first eight weeks of the study, there was no
increase in cardiovascular risk in the carvedilol group. Instead, fewer
patients died and fewer were hospitalized than in the placebo group. Worsening
of heart failure was the only serious side effect of the drug and was reported
with a similar frequency in both groups.
"Beta-blockers are not being used enough in the treatment
of heart failure patients," says Pinski, who wrote an editorial
accompanying the two studies. "It has become clear that almost every
patient with systolic dysfunction or heart failure should be on a
beta-blocker." Pinski is head of cardiac pacing in the cardiology
department of Cleveland Clinic Florida.
In the other JAMA study, researchers from Baltimore's
Johns Hopkins Medical Institutions reported that implantation of a specialized
pacemaker reduced deaths by half and reduced hospitalization by a third among
1,634 heart failure patients.