New developments in the management of heart failure: a review of the literature in 2002.
In 2002, several studies were directed at new developments in the management of heart failure. In the COPERNICUS study, the previously reported benefits of the beta-adrenoreceptor blocker carvedilol regarding morbidity and mortality in patients with mild-to-moderate heart failure were also found in patients with severe heart failure. Carvedilol not only improves survival but when given in addition to conventional therapy, ameliorates the severity of heart failure and reduces the risk of clinical deterioration, hospitalisation and other serious adverse events. The diagnostic value of B-type natriuretic peptide (BNP) in patients with congestive heart failure has been a topic of study for the past five years. Many questions still need to be answered but the results of a study by Maisel et al. show that BNP is not only of diagnostic value but is also important for prognosis and evaluation of therapy. A substudy of the Val-HeFT study focussed on the effects of the angiotensin receptor blocker valsartan on BPN and noradrenaline levels. Valsartan significantly reduced the combined endpoint of mortality and morbidity and improved clinical signs and symptoms in patients with heart failure, if added to prescribed therapy. However, in a post-hoc observation an adverse effect on mortality and morbidity was seen in the subgroup receiving valsartan, an ACE inhibitor and a beta-blocker, which raised concern about the potential safety of this specific combination. And finally, interesting work by Abraham et al. on cardiac resynchronisation through atrial-synchronised biventricular pacing clearly shows that this therapy can produce a significant clinical improvement in patients with moderate-to-severe congestive heart failure and intraventricular conduction delay.
van der Sloot
J A P
JA
Department of Cardiology and of Intensive Care Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
D009320:Atrial Natriuretic Factor / Q000097:blood; D002304:Cardiac Pacing, Artificial / Q000379:methods; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D020097:Natriuretic Peptide, Brain; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
D002317:Cardiovascular Agents; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor