Study shows hope for heart failure patients

Patients with heart failure still carry a high rate of death and re-hospitalization. There is still a big need to come up with new therapies which can significantly optimize treatment of patients suffering from heart failure.

Angiotensin receptor blockers (ARB), a class of drugs popularly prescribed for high blood pressure, are filling in this need.

This was one of the highlights in last week’s annual convention of the Heart Failure Society of the Philippines (HFSP), currently headed by Dr. Romeo Divinagracia, a well-respected cardiologist who is also a past president of the Philippine College of Cardiology and the Philippine College of Physicians.

Among the most common causes of heart failure are high blood pressure and coronary heart disease characterized by the narrowing of the arteries supplying the heart. The chances of heart failure increases when one develops a heart attack, which may lead to the weakening of the heart muscles.

"In heart failure, the heart is no longer able to fulfill adequately its function of pumping the blood into the circulation to nourish all the parts of the body," Dr. May Donato-Tan, an HFSP officer, said.

According to Tan, symptoms may develop insidiously so that heart failure patients may hardly notice them or attribute them to something else.

She added that one should suspect heart failure if they have the following signs and symptoms:

• Shortness of breath on exertion and even at rest in severe cases;

• Difficulty of breathing when lying down;

• Nocturnal dyspnea or waking up at night feeling a drowning sensation;

• Swelling of the legs due to edema, progressing upwards;

• Rapid increase in weight due to water retention; and

• Engorgement of the neck veins.

Patients are immediately advised to see their doctors when they have any of these symptoms, so immediate treatment could be implemented.

Heart failure patients are generally advised therapeutic lifestyle changes (TLCs), which include quitting smoking and excessive alcohol drinking, avoiding strenuous activities and cutting down on their salt and water intake.

Candesartan is a member of the ARB family cited for its beneficial effects in all groups of patients with heart failure. Three trials of candesartan among patients with heart failure showed benefits on top of other concomitant therapies, including angiotensin converting enzyme (ACE) inhibitors and beta-blockers.

The study, with the acronym CHARM (Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity), was one of the highly awaited landmark trials presented in the European Congress of Cardiology in Vienna recently. The trial results were also presented in the HFSP convention.

The CHARM trial was conducted at 618 sites in 26 countries and included 7,601 symptomatic patients across a broad spectrum of disease severity. It consisted of three separate independent trials called CHARM-Alternative, CHARM-Added and CHARM-Preserved.

The CHARM overall program is considered the most extensive landmark trial in the use of ARB in heart failure.