More on the Heart

Experts in the Heart and Circulatory specialty area (Cardiologists) are saying that improvements in drug therapy can prevent up to 100,000 deaths yearly. They are now recommending earlier and more aggressive treatment for systolic heart failure. Accordingly, cardiologists say patients should be getting a combination of an ACE inhibitor (Angiotensin Converting Enzyme: a drug that lowers blood pressure), a diuretic, a beta-blocker (drug that slows the heart rate and lowers blood pressure), and digoxin (commonly referred to as a heart muscle tonic).

According to the specialists, not enough heart failure patients get ACE inhibitors and beta-blockers. Statistically, only 40% of the patients are on ACE inhibitors, and those are usually taking a lower than optimal dose for chronic heart failure (CHF). Only 5% of heart failure patients are on beta-blockers.

Patients with Systolic Heart Failure should be taking ACE inhibitors unless they demonstrate an intolerance to them or exhibit an interaction with other drugs they may be taking. In that case, the probability is that Angiotensin II blockers can be substituted for the ACE inhibitors. Diuretics (drugs used to reduce excess fluid in the body) should never be used alone but as an adjunct to the ACE inhibitors.

It is recommended that Beta-blockers should be given to most patients who still have symptoms regardless of being treated with Ace inhibitors and diuretics. Physicians have shown great reluctance to use blockers in heart failure patients because they decrease contractility and slow the heart rate, but blockers actually improve heart function. That may be due to their blocking the effects or the sympathetic nervous system.

It is best to avoid Beta-blockers if the patient has conditions such as Asthma, Chronic Obstructive Pulmonary Disease (COPD) or an advanced heart block. The only beta-blocker currently approved for use in heart failure is Coreg (Carvedilol). Digoxin is recommended for the improvement of symptoms and exercise tolerance but has no effect on survival time.

One point to remember is that NSAIDS (non steroidal anti-inflammatory drugs) can slow or stop the effectiveness of ACE inhibitors and diuretics. They may also cause deterioration of cardiac and renal functions.

AMIODARONE

Arrhythmias are not uncommon in heart failure patients but are quite difficult to treat. It is for that reason more physicians are turning to a drug called Amiodarone (Cordarone). Quinidine and other antiarrhythmics tend to push up the mortality rate. That's where Cordarone differs. It does help control arrhythmia and one benefit of using the drug is possible improvement in survival times.

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