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Gains Against Heart Failure Reported
Date:11/11/2008

Exercise, medications prove worth against the condition, doctors say

TUESDAY, Nov. 11 (HealthDay News) -- Researchers are reporting new ways to use exercise and medications to manage and improve the lives of people with heart failure, a condition that affects more than 5 million Americans.

One study found a small, 7 percent reduction in death or hospitalization rates from any cause, as well as a reduction in cardiovascular mortality and heart failure hospitalizations, among heart-failure patients who followed a specific exercise regimen.

"This is the largest and most comprehensive study of exercise training in patients with heart failure," said study lead author Dr. Christopher O'Connor, director of the Duke University Heart Failure Program in Durham, N.C. "It supports a structured exercise training program for patients with reduced left ventricular function and heart failure symptoms, in addition to evidence-based therapy."

O'Connor spoke along with authors of other studies at a Tuesday news conference at the American Heart Association's annual scientific sessions, in New Orleans.

Half the patients in O'Connor's study were randomly selected to receive standard medical therapy plus advice on how to exercise. The other half -- the "intervention arm" -- received supervised exercise training before a transition to home-based exercise, usually a treadmill. The goal was to work up to 40 minutes of moderate-intensity exercise at home five times a week for two-and-a-half years. The second group also received follow-up phone calls monitoring exercise progress.

The next goal is to figure out what sort of exercise is most beneficial and how to get people, not just heart-failure patients, to adhere regularly to an exercise program, Dr. Philip Poole-Wilson of Imperial College London and the British Heart Foundation, said at the news conference.

"The study also showed the exercise was safe, but safety without benefit is a bit dull really," Wilson added.

In other research presented Tuesday, a phase II trial found that interferon, a drug used for both hepatitis and neurological disorders such as multiple sclerosis, eliminated or reduced three viruses from heart-failure patients who had evidence of persistent viral infection.

There was also a slight trend toward better cardiac function and quality of life, though not a statistically significant one, the German study authors said.

"Future trials will test clinical efficacy and how that balances the inconvenience and cost," said Dr. Michael Felker, of the Duke Heart Center. One course of the drug costs about $10,000, and patients need to receive injections every other day.

Another study presented Tuesday found that a so-called biomarker -- a hormone called mid-regional pro-adrenomedullin (MR-pro-ADM) -- was superior to the best established biomarkers for predicting if patients coming to an emergency room with shortness of breath and a diagnosis of heart failure would be dead or alive at 90 days. The marker was even better at predicting outcomes at 30 days, the study authors said.

"Taking a simple blood sample at the time of admission and being able to predict prognosis for 30 days adds to the ability to triage patients and push those patients with the highest medical need to the front line of medical care," said Dr. Stefan D. Anker of Charite Medical School in Berlin, Germany.

But, Dr. Milton Packer, chair of the Department of Clinical Sciences at the University of Texas Southwestern Medical Center at Dallas, questioned whether medicine really needs another biomarker for this purpose. "You can't use this to push patients to the front of the line, because everyone should get optimal therapy for chronic heart failure," he said.

More information

The American Heart Association has more on heart failure.



SOURCES: Nov. 11, 2008, news conference at the American Heart Association scientific sessions, New Orleans, with: Christopher O'Connor, M.D., director, Duke University Heart Failure Program, Durham, N.C.; Philip Poole-Wilson, M.D., Imperial College London and British Heart Foundation; Michael Felker, M.D., Duke Heart Center, Durham, N.C.; Stefan D. Anker, M.D., Charite Medical School, Berlin, Germany; Milton Packer, M.D., University of Texas Southwestern Medical Center at Dallas


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