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What happens to stable heart failure patients when they don't take their medicines?
Author(s) -
Ahmad Tariq,
Testani Jeffrey M.
Publication year - 2017
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.803
Subject(s) - heart failure , medicine , hindsight bias , nesiritide , intensive care medicine , disease , cardiology , psychology , natriuretic peptide , cognitive psychology
The bedrock on which existing knowledge in cardiology rests comprises studies involving only a handful of patients—what was central to this research was the uniqueness of the research question rather than the size of the cohort. In contemporary times, however, we assume that the ‘low hanging fruit’ of cardiovascular knowledge has already been gathered, and any additional advancements in our understanding of disease pathophysiology will come from investigations on a substantial scale. It is therefore quite refreshing when researchers rely on creativity rather than brute force and perform studies like the one presented by Dr Cleland’s group in this issue of the European Journal of Heart Failure that challenge our basic assumptions about heart failure, all with less than two dozen patients.1 In hindsight, the question they sought to answer was surprisingly simple, and yet previously unanswered: what are the effects of not taking heart failure medications on key disease parameters in patients with stable disease? For this, they recruited 20 outpatients with stable systolic heart failure who were on guideline recommended therapies, including sufficient doses of loop diuretic, and had NT-proBNP levels of >200 ng/L. Using a randomized cross-over design, they subjected the patients to 48 h of medication continuation and omission. A host of parameters relevant to heart failure pathophysiology were collected, specifically: weight, blood pressure, heart rate, NT-proBNP, creatinine, detailed echocardiographic data, and bioimpedance information. They found medication omission to be associated with an increase in systolic blood pressure, an almost doubling in NT-proBNP levels, and a decrease in creatinine. There was significant worsening in echocardiographically determined left atrium and left ventricle volumes, and increases in both transthoracic and total body impedance. Of note, there was no significant increase in body weight with medication omission.