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[Clinical trials on heart failure]

J Cosín Aguilar1, A Hernándiz Martínez

  • 1Centro Investigación, Hospital La Fe, Valencia, Spain.

Revista Espanola De Cardiologia
|September 6, 2001
PubMed

Insights

Heart failure treatment has advanced with angiotensin-converting enzyme inhibitors (ACEIs) and beta-blockers proven to reduce mortality. While some drugs improve quality of life, evidence supports specific medications for chronic heart failure management.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • The Consensus study (1987) established enalapril, an angiotensin-converting enzyme inhibitor (ACEI), as effective in modifying heart failure and reducing mortality.
  • Subsequent studies confirmed ACEI efficacy across various heart failure degrees, left ventricular dysfunction, myocardial infarction, and in diabetic patients.
  • Beta-blockers (carvedilol, bisoprolol, metoprolol) demonstrated effectiveness in reducing deaths from progressive heart impairment and sudden death in chronic heart failure (1996).

Purpose of the Study:

  • To review the evidence supporting current pharmacological treatments for chronic heart failure based on multicenter trials.
  • To highlight the impact of specific drug classes, including ACE inhibitors, beta-blockers, and spironolactone, on heart failure prognosis.
  • To discuss limitations of clinical trials, such as patient selection and trial design, and their impact on treatment adoption.

Main Methods:

  • Review of landmark multicenter clinical trials, including the Consensus study, RALES, CIBIS, MCD, and ELITE.
  • Analysis of drug efficacy data for angiotensin-converting enzyme inhibitors, beta-blockers, spironolactone, digitalis, and amiodarone.
  • Evaluation of the translation of trial findings into clinical practice and patient management.

Main Results:

  • ACE inhibitors and specific beta-blockers significantly reduce mortality in chronic heart failure.
  • Spironolactone (low doses) improves prognosis, while digitalis enhances quality of life but not survival.
  • Amiodarone is the only antiarrhythmic shown to reduce sudden cardiac death.
  • Multicenter trials provide crucial evidence, but often exclude specific populations (women, elderly, severe cases) and can suffer from design or interpretation flaws.
  • Knowledge from trials is slow to reach patients, leading to underutilization of effective therapies like beta-blockers at recommended doses.

Conclusions:

  • Evidence from multicenter trials supports the use of ACE inhibitors, beta-blockers, and spironolactone for managing chronic heart failure.
  • Limitations in trial design and patient inclusion, along with slow knowledge dissemination, hinder optimal treatment of heart failure patients.
  • Further research and improved strategies are needed to ensure effective heart failure therapies reach all appropriate patient groups.

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