Monday, October 19, 2009


Heart failure is a clinical situation where the heart is unable to pump out enough blood to sustain an adequate circulation to maintain life. This is usually due to failure of the heart as a muscular pump. Damage to heart muscle, as a result of heart attacks and heart artery blockages, are amongst the most common causes. Heart muscle failure due to infections by viruses, and also toxins like alcohol are also other common causes.
Whatever the causes, once the heart muscle cannot pump, we have diagnose heart failure. Medical science has been working very hard to find ways and means of improving heart muscle function to help heart failure. Reducing circulatory volume is another way. Improving the efficiency of the circulation is yet another approach. Some of these approaches improve quality of life. Others are able to also improve quantity of life. With these approaches, we have drugs like ACE-I, ARBs, beta-blockers, diuretics, vaso-dilators, etc., etc..
It is fair to say that over the last two years, there have been almost no advances in the use of drugs to improve heart failure. In fact over the last two years, interventionist have moved on with the use of special pacemakers to treat certain sub-groups of patients with heart failure. This came across quite loudly at the last annual scientific meeting of the Heart Failure Society of America 2009, when some experts sat in at a special session to represent the results of some studies done earlier and presented in 2008, of an important paper by the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico Heart Failure (GISSI-HF) trial. Dr Mihai Gheorghaide of the North Western University, Feinberg School of Medicine, Chicago, and his colleagues, rehashed the results of GISSI-HF. This was a 4 year followup study by the Italian GISSI group. They studied 7,00 patients with class 2-4 heart failure who were on standard, maximal heart failure therapy ( including beta-blockers, ACE-I, vasodilators, diuretics and spironolactone ). One arm was given placebo and the other arm was given omega-3 PUFA ( fish oils )1 gm daily. The authors showed that the patients given the omega-3 PUFA ( fish oils ) had a 9% reduction in all cause mortality and an 8% reduction in the composite endpoint of cardiovascular mortality and cardiovascular hospitalisation. It was important to note that these improvements came on top of maximal standard heart failure therapy. This is very significant.
I am rather impressed with the findings, as fish oils is much cheaper then the pharmacotherapy and is relatively free of side effects ( baring the mercury in some of the fish oil tablets ). Fish is something that all of us ingest regularly in varying amounts.
On closer inspection, it appears that fish oils have profound CVS effects. It was found to reduce heart rates, vasodilates, anti-apototic, neurohormonal modulation, reduce O2 consumption, anti-fibrosis, anti-arrhythmic, amongst other effects. Whether all of these are clinically significant is left to be proven. But what is ceratin is that less people die from arrhythmic deaths and all cause mortality, when they are on fish oils.
It is good to know, every now and then that something cheap and natural, could be good and effective. There is still an increase role of fish oils and omega-3 polyunsaturated fatty acids. I certainly think that fish oils should be used in management of heart failure, in order to improve outcomes.

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