Some current controversies in heart failure (2004-2005).
The disparity between what doctor's believe and the medical facts can be frightening at times. This reflects centuries of training on how to manage patients in the absence of evidence to guide practice. Increasingly disease is becoming susceptible to treatment, requiring a change in the professional approach from the educated, hopeful guess to the application of objective data. Arrogance and certainty, born of ignorance and clutching in desperation at imaginary straws probably still have a place in medicine when conventional treatment has failed, but should play a diminishing role within the medical profession. Epidemiological association is no longer sufficient evidence to conclude that an intervention is effective; with few exceptions, randomised-controlled trials are required. A more successful and objective era of medical practice has arrived. Consequently, a greater degree of scepticism about claims of benefit is also appropriate, which should apply equally to treatments new and old. Of course, no 2 patients are alike, and the evidence-base remains a guide-map on how patients should be treated, rather than a set of rigid rules. Guidelines are guidelines and not infallible, inviolable decrees. In this article, some of the current controversies in the management of heart failure are discussed, ranging from diagnosis, diastolic heart failure, and the role of natriuretic peptides, to the lack of evidence for a clinically-relevant benefit (and therefore possible harm) from aspirin, statins, implantable defibrillators or revascularisation.
Cleland
J G F
JG
Department of Cardiology, University of Hull, Kingston upon Hull, UK. g.m.porter@hull.ac.uk
Loh
H
H
Windram
J
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000465:Algorithms; D057911:Angiotensin Receptor Antagonists; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000451:Mineralocorticoid Receptor Antagonists