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 prolong life."
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.
Lead researcher David J. Bradley, MD, PhD, and colleagues reviewed four clinical trials comparing patients with heart failure who got the special pacemakers with those who did not get them. Patients who received the pacemaker therapy, known as cardiac resynchronization, had improved heart function, improved exercise capacity, and improved quality of life. At three to six months follow-up, 1.7% of the pacemaker patients had died compared with 3.5% of those without pacemakers. Heart failure-related hospitalizations were also reduced by 29% among pacemaker patients.
Bradley tells WebMD that pacemakers represent a promising treatment option for patients who have had few options in the past. The devices may also allow patients to tolerate larger doses of beta-blocker drugs.
"Beta-blockers tend to slow the heart down, but the pacemakers prevent that from happening," he says. "Right now we don't know just how big an impact there will be for patients treated with both of these therapies, but it is very exciting."