title: "Triple therapy" of heart failure with angiotensin-converting enzyme inhibitor, beta-blocker, and aldosterone antagonist may triple survival time: shouldn't we tell patients?
abstract: Prescription and adherence to medical therapy for heart failure are disappointing despite convincing randomized controlled trial (RCT) evidence for angiotensin-converting enzyme inhibition, beta-blockade, and aldosterone antagonism. In this study, we report an imbalanced approach amongst clinicians, who describe focusing during patient consultations on perceived risks of therapy rather than survival benefits. Only one-half of clinicians mention increased lifespan, and very few suggest to the patient how large this gain might be. We calculate from the available RCT data that, for patients whose lifespan is limited by heart failure, triple therapy triples lifespan.
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom. Electronic address: g.cole@imperial.ac.uk.
authors.forename: Graham D
authors.initials: GD
authors.lastname: Cole
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: Sheetal J
authors.initials: SJ
authors.lastname: Patel
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: Nabeela
authors.initials: N
authors.lastname: Zaman
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Barron
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Raphael
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: Jamil
authors.initials: J
authors.lastname: Mayet
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, United Kingdom.
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D055118:Medication Adherence; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D010353:Patient Education as Topic; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists
keywords: adrenergic; aldosterone antagonists; angiotensin-converting enzyme inhibitors; beta-blockers; heart failure; life expectancy