title: Principles governing heart failure therapy re-examined relative to standard evidence-based medicine-driven guidelines.
abstract: Although all aspects of clinical work nowadays are modified by the pervading influence of evidence-based medicine (EBM) and multiplicative guidelines, not many clinicians realize that the underlying premise of EBM-driven guidelines is a particular strain of consequentialist ideology. Subservience to this ideology has transformed modern medical practice, but there is a real risk of distorting good medical practice, of belittling clinical judgement, of disempowering clinicians, and subjecting patients to skewed medical reality and treatment options. With so many heart failure (HF) guidelines issued by various august bodies, it is therefore timely to reappraise principles governing modern HF therapy with a fresh examination of the hierarchy of medical imperatives, the role of alternatives to consequentialism including deontological principles in HF therapy. In addition, other ideology worth re-examining, aside from EBM, are the principle of appropriate definition of HF underlying therapeutic goals and the principle of prioritizing objectives of HF therapy. Even within standard EBM, there are many questions to reconsider: about what types of evidence are admissible, different interpretations of available evidence, emphasizing patient-centered outcome measures instead of randomized controlled trials quantifiable therapeutic outcomes, how to prescribe drugs for prognostic versus symptomatic benefits, and how to deliver HF therapy based on pathophysiological features through mechanistic considerations and not just confined to randomized controlled trials or meta-analytical statistical imperatives. Through re-examination of these fundamental principles of HF therapy, it is hoped that clinicians will be empowered to manage HF patients more holistically and better deliver HF therapies in the best interest of each individual patient.
authors.affiliation: Leeds General Infirmary, Great George Street, Leeds, UK.
authors.forename: Lip-Bun
authors.initials: LB
authors.lastname: Tan
authors.forename: Shanmugakumar
authors.initials: S
authors.lastname: Chinnappa
authors.forename: David K H
authors.initials: DK
authors.lastname: Tan
authors.forename: Alistair S
authors.initials: AS
authors.lastname: Hall
mesh_terms: D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006694:Holistic Health; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011379:Prognosis