Pharmacotherapy for heart failure in patients with renal insufficiency
Article Abstract:
Clinical trials have demonstrated that angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and spironolactone improve survival in patients with heart failure. Because patients with heart failure and renal insufficiency have been underrepresented in these trials, little evidence is available to guide clinicians in the optimal management of patients with both conditions. Approximately one third to one half of patients with heart failure have renal insufficiency (estimated glomerular filtration rate [GFR] <60 mL/min per 1.73 m(2)), and renal insufficiency is among the strongest predictors of mortality in patients with heart failure. Evidence supports the use of ACE inhibitors to improve survival in patients with moderate renal insufficiency (GFR, 30 to 60 mL/min per 1.73 m(2)), but there is little evidence with which to weigh the risks and benefits in patients with more advanced renal dysfunction. Beta-blockers improve survival in patients with heart failure, and their beneficial effect is unlikely to differ according to renal function. Spironolactone improves outcomes in patients with advanced heart failure, but renal insufficiency appears to increase risk for hyperkalemia and limits the use of the drug in patients with severe renal insufficiency. Future clinical trials in heart failure should include a representative number of patients with renal insufficiency to improve the evidence base and outcomes in this vulnerable population.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 2003
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Applying evidence to patient care: from black and white to shades of grey
Article Abstract:
Doctors should feel comfortable applying the results of clinical trials to their own patients even if their patients have medical conditions that would have excluded them from participation in the trial. For example, many clinical trials of heart failure treatments exclude patients who also have kidney disease. However, these patients make up one-third of all heart failure patients. They will most likely benefit from the same treatments provided they are closely followed.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 2003
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Ibopamine: a drug that has opposite effects depending on the severity of a patient's disease
Article Abstract:
A change in the prescribing of the drug ibopamine has reduced the number of patients who have died while taking it. This drug is used to treat heart failure but it can increase the risk of death in patients with moderate to severe heart failure. Consequently, in 1995, doctors were told to use the drug only in patients with mild heart failure.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 2001
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