Two new studies offer promising therapies for people with mild to moderate heart failure.
In the first, a two-in-one device that improves the heart’s pumping ability and corrects abnormal heart rhythms was shown to reduce death and hospitalization rates in this group.
The second found that the Pfizer drug Inspra, or eplerenone, also cut heart failure deaths and hospital trips in people with mild heart failure.
Both studies were published online Sunday in the New England Journal of Medicine to coincide with their release in Chicago at the American Heart Association’s scientific sessions.
Of the 5 million Americans who suffer from heart failure, roughly 10 to 20 percent of them are in the mild to moderate category, said Dr. Anthony S.L. Tang, of the University of Ottawa Heart Institute, who was lead author of the first study.
Tang’s study helped answer the question of whether a device that combines what’s known as cardiac resynchronization therapy with an implantable defibrillator would improve outcomes for people with mild to moderate heart failure, as it has in people with severe heart failure.
The findings are “the first step toward a modification of the guidelines to increase the use of these devices,” said Dr. Gordon Tomaselli, president-elect of the American Heart Association, who was not involved in the research.
Heart failure occurs when the heart can’t pump enough blood to meet the body’s needs.
Patients who receive cardiac resynchronization therapy are surgically implanted with a device that uses electrical impulses to make the bottom two chambers of the heart pump more efficiently.
An implantable cardioverter-defibrillator (ICD) monitors heart rhythm and delivers a shock to the heart if it beats irregularly.
In the study, nearly 1,800 patients from 34 centers were randomly assigned to be implanted with either a combined cardiac resynchronization/defibrillation device or a defibrillator alone. All of the patients also received heart medication.
After an average 40 months of follow-up, 33 percent of the patients who received resynchronization with defibrillation had either died or been hospitalized for heart failure, compared to 40 percent of patients who received defibrillation alone.
But the number of device-related complications, such as infections, in the combined therapy group was almost double that of the ICD-only group (118 vs. 61), researchers reported.
Tomaselli said the increased complication rate with combined therapy was “very mild” and largely due to the more complex surgical procedure involved.
Despite the positive findings, a key question is whether adding cardiac resynchronization to defibrillation is actually cost-effective.
The average cost of a cardiac resynchronization/defibrillator device is roughly $50,000, excluding the expense of having the device surgically implanted, Tomaselli said. That’s about $10,000 more than an ICD alone.
And according to the study, 14 people would need to be treated for five years to prevent one death.
“On the one side of the coin is the cost of the procedure and the cost of the device,” Tang said. “On the other side of the coin is the cost of hospitalization. Do you have savings? We still have to analyze that.”
In the second study, the drug Inspra reduced deaths from cardiovascular causes and hospitalizations by 37 percent, compared to a placebo, when added to standard heart failure therapy. The Pfizer-funded trial, involving 2,700 patients with mild heart failure, was halted early when the survival benefit of taking Inspra became apparent.
The drug is already approved for use in patients with more advanced heart failure.
An accompanying editorial in the New England Journal of Medicine said the study results “have added real value to the management of heart failure.”
But in light of the cost of eplerenone compared to less expensive drugs used in this population, editorial author Dr. Paul W. Armstrong, of the University of Alberta, questioned whether eplerenone might be better used as a second choice treatment for patients who don’t respond to other medication.
In other research presented:
- Women who reported high stress on the job were 40 percent more likely to experience a cardiovascular event, such as a heart attack or stroke, than women in low-stress positions, according to a study of more than 17,000 healthy women. Women with high-stress positions were also more sedentary and more likely to have a high body mass index -- two factors that can influence heart disease risk.
- Cutting teenagers’ salt intake by at least 3 grams a day could reduce their risk of developing high blood pressure, heart disease and stroke in adulthood, a computer analysis suggests. The average American teen eats more than 9 grams of salt a day, more than any other age group. Pizza is the largest source of sodium for teenagers, according to the National Center for Health Statistics.
- Parents and spouses of the recently deceased were more likely to experience an increase in heart rate and other heart rhythm abnormalities than non-bereaved parents and spouses. These abnormalities tended to disappear within six months of a loved one’s death. The 78 bereaved parents and spouses who participated in the study were family members of people who had been treated in hospital intensive care units. It’s not clear whether the same changes would be observed in people whose loved ones had died in hospice or at home, the study’s authors said.
source: suntimes
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