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Some Elderly Heart Failure Patients Get Little Help From Meds, Study Finds
Date:3/12/2009

ly prescribed drugs -- including statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta blockers, diuretics, calcium channel blockers, nitrates and digoxin -- seemed to make any significant difference in who survived and who died.

"At least for patients above the age of 80 with diastolic heart failure, whether they are treated or not with these kind of medications does not affect their mortality or their long-term outcome," Schwarz said.

Dr. Byron Lee, a cardiologist and assistant professor of medicine at the University of California, San Francisco, appeared skeptical of the findings.

"I would be very cautious when drawing conclusions from this study," Lee said. "This is not a randomized, controlled study. The patients on the cardiovascular drugs might have been much sicker than the comparison group. Therefore, the drugs may have actually had a big impact -- keeping the sicker patients alive as long as the ones not on heart medications."

Schwarz, however, speculated that lower doses of the drugs might be appropriate for people with diastolic heart failure. In any case, he said, more research is needed, as are better treatment guidelines.

"We really don't have a clue how to treat them and how to treat them better," Schwarz said. "We are at the beginning of a learning curve to try to understand the changes in the elderly organism, which might require more caution with certain drugs, more dose adjustments. We need too look at the very elderly patient in a different way."

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said that better treatments need to be found for people suffering from diastolic heart failure.

"Patients who have heart failure with preserved systolic function represent half of the 5 million patients with heart failure in the United States," Fonarow said. "These patients face substantial risk for morbidi
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