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Effect of drug therapy on survival in chronic congestive heart failure
1Bowman Gray School of Medicine, Winston-Salem, North Carolina 27103.
Abstract:
A review of the current evidence on the effects of various agents on survival among patients with congestive heart failure (CHF) suggests that angiotensin-converting enzyme inhibitors probably offer the greatest potential for benefit. Trials undertaken before the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) revealed favorable trends among patients in New York Heart Association functional classes II to IV who received angiotensin-converting enzyme inhibitors. Data from CONSENSUS clearly demonstrate that enalapril reduces mortality rates among patients in New York Heart Association class IV, but conclusions regarding effects in patients with mild or moderate CHF must await the results of future studies. In contrast, the large data base on alpha-adrenergic blockers suggests that these drugs are not likely to improve survival. Information on inotropic agents is sparse, but it is possible that these drugs may not improve survival and, in fact, may have a harmful effect. Mortality data on CHF patients treated with beta blockers and calcium channel blockers are likewise limited; conclusions concerning effects on survival must be postponed until further studies are conducted. Many of the investigations undertaken thus far to examine survival in patients with CHF have been small and of short duration, so any comparisons of the effects of various drugs must be interpreted with caution.
Insights
Angiotensin-converting enzyme inhibitors show the most promise for improving survival in congestive heart failure (CHF) patients, particularly those with severe symptoms. Further research is needed for other drug classes, as current evidence is limited or suggests potential harm.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) survival is influenced by various pharmacological agents.
- Previous trials indicated potential benefits of angiotensin-converting enzyme inhibitors (ACEIs) in CHF patients.
Purpose of the Study:
- To review current evidence on the efficacy of different drug classes in improving survival for patients with congestive heart failure.
- To identify agents with the greatest potential for benefit in CHF management.
Main Methods:
- Systematic review of existing clinical trial data and published literature on CHF pharmacotherapy.
- Analysis of survival trends associated with ACEIs, alpha-adrenergic blockers, inotropic agents, beta blockers, and calcium channel blockers.
Main Results:
- Angiotensin-converting enzyme inhibitors (ACEIs) demonstrate the greatest potential for improving survival in CHF patients.
- The Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) confirmed enalapril's mortality benefit in New York Heart Association class IV CHF.
- Evidence for alpha-adrenergic blockers suggests no survival benefit, while inotropic agents may be harmful. Data on beta blockers and calcium channel blockers are insufficient.
Conclusions:
- ACEIs are likely the most beneficial agents for CHF survival, especially in severe cases.
- Further studies are required to establish the role of other drug classes, including beta blockers and calcium channel blockers, in CHF management.
- The limited duration and size of many studies necessitate cautious interpretation of comparative drug efficacy in CHF.