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New Guidelines for Treating Heart Failure
Date:3/26/2009

ive drugs including nitroglycerine," Jessup said. "The guidelines also stress the role of evidence-based medicine and also what should be considered in the discharge of a patient from the hospital."

Special consideration is given to blacks, she said, because "heart failure has a different etiology [cause] and tends to occur younger" in blacks than in others. The guidelines stress the use of two drugs, hydralazine and isosorbide dinitrate, in blacks. Both relieve pressure on the heart by relaxing blood vessels.

"A trial showed that using them in a fixed-dose combination produced a remarkable reduction in mortality in African-Americans, and we really wanted to strengthen the recommendations that they should be used in African-Americans," Jessup said.

The drugs are effective, because heart failure in blacks has been shown to be more related to high blood pressure than it is in whites, she said. "Also, African-Americans with heart failure don't seem to have as much coronary disease," or blockage of the heart arteries, Jessup said.

One revised section of the guidelines contains simplified advice on implantable cardioverter defibrillators, which can prevent sudden cardiac death by delivering a shock to restore normal heart rhythm when the heart suddenly beats irregularly. Various guidelines on the use of these devices have been issued, Jessup said, "and we are trying to simplify what we have said about them," Jessup said.

Also revised is the guideline section on treatment of people who have both heart failure and the arrhythmia called atrial fibrillation. There has been a debate about whether it is better to center treatment on relieving heart failure or on restoring normal heart rhythm, Jessup said. Several studies have shown that neither strategy is superior, and so the guidelines say a decision should be based on individual patient characteristics, she said.

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