Wide Range of Drugs Now Available To Effectively Treat Chronic Heart Failure

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The summary below is from the full report titled "Narrative Review: Pharmacotherapy for Chronic Heart Failure: Evidence from Recent Clinical Trials." It is in the 18 January 2005 issue of Annals of Internal Medicine (volume 142, pages 132-145). The authors are A.T. Yan, R.T. Yan, and P.P. Liu

What is the problem and what is known about it so far?

Heart failure occurs when the heart cannot pump enough blood to the body to supply its needs. When this problem persists, it is called chronic heart failure. Among the most common causes of chronic heart failure are narrowing of the vessels that supply blood to the heart (coronary artery disease) and myocardial infarction (heart attack). Chronic heart failure is a leading cause of hospital admissions and deaths, and is likely to become more common as the population ages. Recent studies have identified many drugs that can relieve the symptoms of heart failure and improve quality of life. Properly used, these drugs may slow the progression of heart failure and prolong survival.

Why did the authors do this review?

To examine current evidence from recent clinical trials on drugs used to treat chronic heart failure.

How did the authors do this review?

They searched a large medical database (MEDLINE) and found about 4000 English-language articles on drug therapy for heart failure published between 1990 and mid-2004.

What did the authors find?

According to more than 30 trials completed before 1995, very strong evidence suggests that a class of drugs known as angiotensin-converting enzyme (ACE) inhibitors can treat heart failure effectively. The more severe the heart failure, the better the response to ACE inhibitors, and benefit of persistent use may continue over many years. Another class of drug known as beta-blockers can substantially reduce the risk for death regardless of the cause of heart failure. These drugs are safe for patients with advanced heart failure. They also may help patients whose heart failure has not yet caused symptoms. Aldosterone, a chemical secreted by the adrenal glands, may increase both the amount of blood in the body and blood pressure. A type of drug known as aldosterone antagonists can benefit patients with more severe heart failure. ACE inhibitors, beta-blockers, and aldosterone antagonists can protect the heart from further damage and slow the progression of heart failure. They have all been shown to improve survival and reduce hospitalizations. For patients who cannot take ACE inhibitors because of the drug's side effects, another class of drugs known as angiotensin-receptor blockers is a good alternative. Diuretics help patients with heart failure get rid of excess fluid by increasing urine flow. Diuretics can improve symptoms of heart failure but are not suitable as the sole treatment. Digitalis has long been used to control heart failure because it increases the force of the heartbeat, alleviates symptoms, and lessens the need for hospital admission. Nitrates and a drug called hydralazine are suitable for patients with heart failure who also have significant kidney disease.

What are the implications of the review?

Numerous drugs are available for treating—and hopefully preventing—heart failure. Today's physicians are challenged to match current information on these drugs with the needs of individual patients.