Matters of the heart.Life-saving drugs for cardiac disease are still underused THE USE OF A FOUR-DRUG REGIMEN COULD IMPROVE AND possibly save the lives of tens of thousands of patients who suffer from a form of congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. , recent research reveals. Yet, up to 60 percent of heart failure patients do not receive the full complement of recommended drugs, a panel of more than 150 leading experts has concluded. In nursing homes, undertreatment is even more common. In a consensus report published in February in the American Journal of Cardiology, doctors recommend most patients be treated with ACE inhibitors and beta-blockers in combination with commonly used digitalis digitalis (dĭj'ĭtăl`ĭs), any of several chemically similar drugs used primarily to increase the force and rate of heart contractions, especially in damaged heart muscle. The effects of the drug were known as early as 1500 B.C. and diuretics Diuretics Definition Diuretics are medicines that help reduce the amount of water in the body. Purpose Diuretics are used to treat the buildup of excess fluid in the body that occurs with some medical conditions such as congestive heart . According to the report, only about 40 percent of patients receive ACE inhibitors and just 5 percent are treated with beta-blockers. "Most primary care physicians need to become more knowledgeable, more experienced in using some of these new drugs," says Jay N. Cohn, MD, co-chair of the steering committee that wrote the report, and professor of medicine at the University of Minnesota Medical School The University of Minnesota Medical School is the medical school of the University of Minnesota. It is a combination of two campuses situated in Minneapolis and Duluth, Minnesota. . The report was based on an 18-month review of available data on the treatment of heart failure, including numerous clinical studies indicating that the use of ACE inhibitors and beta-blockers in combination with digitalis and diuretics can dramatically improve outcomes. Heart failure is primarily "an illness of the elderly," notes JoAnn Lindenfeld, MD, director of the cardiology transplant program at the University of Colorado University of Colorado may refer to:
The report addressed the pharmacological treatment of patients with chronic systolic heart failure systolic heart failure Cardiology Heart failure with a severely reduced systolic function–LV ejection fraction of ≤35%. Cf Diastolic heart failure. , heart failure caused when a weakened heart muscle does not pump blood forcefully enough. Diastolic heart failure diastolic heart failure Cardiology Heart failure with preserved left ventricular systolic function–LV ejection fraction of ≥ 50%, no segmental wall motion abnormalities, and no evidence of significant coronary, valvular, infiltrative, pericardial, or , which occurs when the heart is unable to fill up during the relaxation phase, is caused by stiffening of the heart muscle. There have been no large clinical trials on patients who suffer exclusively from diastolic heart failure. It's likely the treatment recommendations will overlap, says Lindenfeld. To date, researchers have focused on systolic heart failure, believing that the majority of heart failure patients--up to 70 percent--suffer from this form of the disease. Now there is mounting evidence to suggest that the incidence of diastolic heart failure increases with age. Patients can suffer from both forms of the disease. The use of the ACE inhibitors was first recommended in the late 1980s, says William T. Abraham, MD, director of heart failure and cardiac transplantation at the University of Cincinnati The University of Cincinnati is a coeducational public research university in Cincinnati, Ohio. Ranked as one of America’s top 25 public research universities and in the top 50 of all American research universities,[2] College of Medicine and a member of the steering committee. The beta blocker Beta blocker A drug that can be used to reduce blood pressure. Mentioned in: Mitral Valve Stenosis beta blocker Beta-adrenergic blocking agent Pharmacology Any of a class of agents that blocks β1 carvedilol (Coreg) was approved in May 1997 for heart failure. Two other beta-blockers--metotrolol (Toprol XL) and bisoprolol (Zebeta and Ziac)--have been studied and proven effective but have not been approved specifically for heart failure, according to Abraham. In part, ACE inhibitors and beta-blockers may be underprescribed because the use of new drug therapies often lags research, notes Lindenfeld. Doctors also may shun ACE inhibitors and beta-blockers for fear of side effects Side effects Effects of a proposed project on other parts of the firm. that can occur if the drugs are not administered properly. "There is the perception, and it's unfounded, that these newer drugs are difficult to use," says Abraham. That's particularly true with beta-blockers, which relax the heart and cause it to beat more slowly. When initially administered to heart failure patients, the drugs may exacerbate such symptoms as low blood pressure, fluid retention, and fatigue. To avoid such problems, patients should be started on the drugs slowly at first and carefully monitored until the correct and most effective dosage can be determined. In nursing facilities, another deterrent is at work: the cost limits on drugs prescribed by Medicare's new prospective payment system for SNFs. Though the obstacle is not easy to overcome, the development of formularies and clinical pathways can help ensure residents receive optimal medication therapies. All patients with systolic heart failure should receive both ACE inhibitors and beta-blockers, unless they have demonstrated an intolerance for the drugs, conclude researchers. Katherine J. Paul, a freelance writer in Hiram, Ohio, is a frequent contributor to Contemporary Long Term Care. STAT Pharmaceutical news Double duty. The Parkinson's disease Parkinson's disease or Parkinsonism, degenerative brain disorder first described by the English surgeon James Parkinson in 1817. When there is no known cause, the disease usually appears after age 40 and is referred to as Parkinson's disease. drug Requip may help other patients. A study in the March issue of the journal Movement Disorders shows the drug can be effective in treating the Restless Legs Syndrome Restless Legs Syndrome Definition Restless legs syndrome (RLS) is characterized by unpleasant sensations in the limbs, usually the legs, that occur at rest or before sleep and are relieved by activity such as walking. , a disorder characterized by unusual sensations that typically occur deep within the legs. Fighting diabetes. An FDA FDA abbr. Food and Drug Administration FDA, n.pr See Food and Drug Administration. FDA, n.pr the abbreviation for the Food and Drug Administration. panel recommended in April that Avandia, a new diabetes drug, be approved. SmithKline Beecham makes the drug, which works in the same way as Rexulin but appears to have fewer serious side effects affecting liver function. |
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