Recent advances in the drug treatment of heart failure.

Background : We previously described severity of heart failure and ventricular tachycardia (VT) as independent predictors of mortality in patients with cardiac sarcoidosis (CS). Medical treatment for chronic heart failure has been established over the last few decades. Prophylactic use of implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT or CRT-D) have been introduced in patients with severe heart failure. We therefore hypothesized that the prognosis of CS improves due to such advances in the management of heart failure and VT. Methods : To confirm our hypothesis, we analyzed 43 CS patients diagnosed between 1988 and 2006 and treated with corticosteroids. We classified two sequential referral patients diagnosed between 1988 and 1997 (n=19) and between 1998 and 2006 (n=24), and compared treatment and prognosis between the two cohorts. Results : Left ventricular ejection fraction (LVEF) and dimensions were similar between the two cohorts. Although age in the 1988–1997 referral cohort was significantly younger than that in the 1998–2006 referral cohort (54±14years versus 62±10years, p<0.05), survival in the earlier cohort was significantly worse (log-rank=4.41, p<0.05). The 1- and 5-year mortality rates were 88% and 71% in the 1988–1997 referral cohort, and 96% and 92% in the 1998–2006 referral cohort, respectively. The 1998–2006 referral cohort showed significantly higher incidence of ICD or CRT-D implantation (29% versus 6%, p<0.05), β-blocker use (46% versus 6%, p<0.01) and addition of methotrexate (21% versus 0%, p<0.05), and increased maintenance dose (7.0±1.9mg/day versus 5.0±0.9mg/day, p<0.01) compared to the 1988–1997 referral cohort. Multivariate analysis including age, LVEF, and sustained ventricular tachycardia (sVT) identified diagnosis between 1988 and 1997 (hazard ratio [HR]: 19.8, p<0.01) and LVEF (HR: 0.83/1% increase, p<0.01) as independent predictors of mortality. Conclusions : Survival in the recent CS patients is significantly better than previously described. Recent advances in the device therapies and medical treatments including modified immunosuppression alter the clinical outcome in patients with CS.

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When to treat symptomless essential hypertension

Drug and Therapeutics Bulletin ◽

10.1136/dtb.20.14.53 ◽

1982 ◽

Vol 20 (14) ◽

pp. 53-54

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Renal Failure ◽

Essential Hypertension ◽

Drug Therapy ◽

Arterial Pressure ◽

Drug Treatment ◽

Absolute Risk ◽

Sodium Restriction ◽

Cardiovascular Morbidity And Mortality

The risk of cardiovascular morbidity and mortality increases in proportion to the arterial pressure at all ages and in both sexes. Most authorities regard blood pressure above 140 mmHg systolic, 90 mmHg diastolic as abnormal. The absolute risk of raised blood pressure is greater in men than women, men being more liable to coronary disease. Raised blood pressure predisposes to stroke, cardiac ischaemia and heart failure, progressive renal failure, retinal lesions and malignant hypertension. Lowering the blood pressure reduces the risks of these complications. Non-drug measures which can help and are worth considering before drug therapy include regular meditation, sodium restriction, weight reduction, and cessation of cigarette smoking. The efficacy of these is however less well proven than that of drug treatment. This article discusses when drug treatment should be considered. Barritt1 presents the arguments in more detail.

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