In 2002, several studies were directed at new developments in the management of
heart failure. In the COPERNICUS study, the previously reported benefits of the beta-adrenoreceptor blocker
carvedilol regarding morbidity and mortality in patients with mild-to-moderate
heart failure were also found in patients with severe
heart failure.
Carvedilol not only improves survival but when given in addition to conventional
therapy, ameliorates the severity of
heart failure and reduces the risk of
clinical deterioration, hospitalisation and other serious adverse events. The diagnostic value of
B-type natriuretic peptide (BNP) in patients with
congestive heart failure has been a topic of study for the past five years. Many questions still need to be answered but the results of a study by Maisel et al. show that BNP is not only of diagnostic value but is also important for prognosis and evaluation of
therapy. A substudy of the Val-HeFT study focussed on the effects of the
angiotensin receptor blocker valsartan on BPN and
noradrenaline levels.
Valsartan significantly reduced the combined endpoint of mortality and morbidity and improved clinical signs and symptoms in patients with
heart failure, if added to prescribed
therapy. However, in a post-hoc observation an adverse effect on mortality and morbidity was seen in the subgroup receiving
valsartan, an
ACE inhibitor and a beta-blocker, which raised concern about the potential safety of this specific combination. And finally, interesting work by Abraham et al. on cardiac resynchronisation through atrial-synchronised
biventricular pacing clearly shows that this
therapy can produce a significant clinical improvement in patients with moderate-to-severe
congestive heart failure and intraventricular conduction delay.