Sunday, October 15, 2006

New Concepts in CCF Treatment

Congestive cardiac failure is a common condition, especially affecting the elderly. It is defined as the inability of the heart to generate cardiac output sufficient for the body's needs. We now know that although the more commonly appreciated are the systolic heart failure, almost an equal number of older patients also suffer from the more difficult to diagnose diastolic heart failure.

Obviously the importance in diagnosis of heart failure is that proper treatment is vital, as heart failure carries with it a high mortality over five years. The mortality from heart failure over five years is as high that of some cancers (almost 50% over 5 years, in some series).

We have many treatment modalities in the drug treatment of CCF, like frusimide, ACE-I, nitrates, beta-blockers, aldosterone antagonist, and lately the ARBs. Many of these drugs have been used, because of our belief that heart failure is due to a derangement in the sympathetic nervous system, and or the renin-angiotensin-aldosterone system. Well I am certain that all that is true.

In the last issue of the Journal of the American College of cardiology, Japanese workers have reported that they think that the histamine system has somethink to do with heart failure. They published a study that is unique in two ways. Firstly, they used a research technique called data mining (what I call data dredging). This means that they take a study that studied another issue (in this case, the use of H2 receptor blocker like famotidine, in the treatment of peptic ulcer), extract a group who also have heart failure from it, and see how this smaller group (extracted from the larger group), fare during the trial period. Secondly, they found that those patients with heart failure and peptic ulcers, who had received famotidine for their peptic ulcer, had better recovery from their heart failure. They have lower LV end systolic dimensions and perhaps improve LVEF. It begins to make us wonder whether, H2 receptor blockers, have a role to play in CCF, and whether the histamine system (which we always associate with allergies), have a role in heart failure?

This is certainly a new concept. Obviously, much much more work need to be done. But for those of us who treat heart failure, it is good to know that H2 blockers does not do harm, but in fact may do some good.

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