(Circulation. 2000;102:1076.)
© 2000 American Heart Association, Inc.
Editorials |
Progress in Heart Failure Management?
Lessons from the Real World
From the Division of Cardiology, New England Medical Center and Tufts University, Boston, Mass.
Correspondence to Marvin A. Konstam, MD, Division of Cardiology, New England Medical Center and Tufts University, Box 108, 750 Washington St, Boston MA 02111. E-mail MKonstam@Lifespan.org
Key Words: Editorials • heart failure • trials • survival • mortality
In recent years, we have learned a great deal about the pathophysiology of heart failure, and we have demonstrated a significant potential for improved clinical outcomes with medical treatments. However, it is important to continually gauge the impact that this incremental knowledge has had on health outcomes in the real world, within populations beyond those enrolled in clinical trials. The study by MacIntyre et al,1 which examines 66 547 consecutive patients with first-time admissions for heart failure in Scotland, provides an important new look at the population of patients with this condition. It offers an opportunity to grade our accomplishments and to identify new approaches required to improve outcomes further.
This group studied an elderly population (median age, 72 years in men and 78 years in women), evenly distributed between the sexes, with a poor prognosis (1-year mortality, 44.5%). However, the authors identified modest but encouraging improvement in outcomes over the 10-year observation period. In these findings, we see reason for optimism but also reason for concern that our clinical trials are leaving gaps in our knowledge and are not realizing their full potential for translation into improved public health.
For their analysis, MacIntyre et al1 used an
imperfect, yet unique and valuable national database. Databases derived
from clinical trials or registries2 have the advantage of
containing more detailed clinical information; however, the selection
process inherent in their construction limit their usefulness in
providing a true reflection of heart failure across the population.
Furthermore, no such information set has been
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