CHF drug therapy getting more complicated
More than ever, patients need support
The recent trumpeting of spironolactone’s success in treating CHF patients makes it a likely addition to the CHF drug therapy regimen. While it may be good news to be able to offer patients more help with managing their disease (and perhaps helping more of them survive longer) the reality is that things promise to become even more complicated for the average CHF patient.
Stop for a minute and take an inventory of all the drugs a patient has to take — then add one more, says David S. Roffman, PharmD, BCPS, associate professor at the University of Maryland School of Pharmacy in Baltimore and CCU therapeutic consultant with the university’s medical system. There’s an ACE inhibitor, a diuretic, a beta-blocker, and digitalis.
Standard treatment could soon mean 5 drugs
Spironolactone may soon become standard therapy as well. That’s five drugs every day, where as many as three of them can help patients live longer. Add other drugs such as a lipid-lowering medicine and aspirin as well as everything else the patients are taking for their other conditions and the task of keeping the routine going becomes daunting. "The polypharmacy becomes very complex," Roffman says. "People will need a lot of support."
The job of the clinician is to try to help patients understand the role of each medication in managing the disease as well as working out ways the patients can comply with their prescription schedule. "That’s a pretty big task," he says.
And the task promises to continue to become more complex, as researchers continue to look for different drugs that can help CHF patients.
"We’re adding more and more to CHF therapy," says lead RALES researcher Bertram Pitt, MD, of the University of Michigan in Ann Arbor. "As long as what we add increases survivability and reduces hospitalizations, that’s fair enough."
Pitt says it’s important to put CHF in the proper context; the prognosis is often as serious as many different types of cancers, each of which has its own complex treatment regimen.
"Maybe one day, they’ll find a drug that does it all, but until then, as long as individual drugs show benefits, there’s good justification for them," he says.
Roffman adds that research is going where it needs to go, finding the drugs that contribute to better control and increased survivability. It will most likely be an additive process, where many, not one drug, provides what a CHF patient needs. But there’s a catch: For every drug that is helpful, there are big lags from the time studies show drugs are beneficial to getting doctors to prescribe them, then getting patients to take them properly, he explains.
An example is the MERIT study, Roffman says, which tested long-acting metoprolol in predominantly class III and IV CHF patients. In the study overall, 65% of all participants had developed their condition as a result of ischemic heart disease. But only one-fourth of the patients were on lipid-lowering drugs. The drugs are out there, he says, it’s a matter of getting the patients on them and getting patients to take those drugs properly.
"We have a long way to go," he says. "And we’re making therapy very complicated."
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