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Dosages in Combination Therapy Not Related to Number of Medications for Heart Failure: Presented at HF

By Paula Moyer

HELSINKI, FINLAND -- June 22, 2006 -- The number of medications a patient with heart failure receives does not influence the dosages of any of the drugs, according to a study presented here at the Heart Failure Congress of the European Society of Cardiology (HF).

These findings are reassuring because they suggest there is little if any drug-drug interaction among these drugs, the investigators reported in a presentation on June 19^th. Therefore, physicians can adjust the dosages for maximum control of heart failure rather than to bypass toxicities, said principal investigator Patrick Assyag, MD, consultant cardiologist, Saint Antoine Hospital, Paris, France.

He and his co-investigators wanted to know how many medications physicians were using to treat patients with left ventricular systolic dysfunction, and whether combination therapy was affecting the dosages used for such drugs.

They conducted a survey between September, 2004, and March, 2005, which involved 1,917 patients with left ventricular ejection fraction <40% and disease severity class II to IV according to New York Heart Association (NYHA) classification. A total of 515 cardiologists were involved in the care of these patients.

Patients were an average of 70 years old and among them, 36% had been hospitalized in the preceding 6 months, and mean left ventricular ejection fraction was 33%.

Almost all patients (84%) were on loop or thiazide diuretics, the most commonly used medications, and 71% were also taking angiotensin converting enzyme (ACE) inhibitors. Other commonly used medications were beta blockers (65%), spironolactone (35%), and angiotensin II receptor blockers (ARBs, 21%).

Almost all patients (92%) were taking 2 to 4 drugs for their heart failure. Of these, 61% were taking both a beta blocker and either an ACE inhibitor or an ARB, 84% also were taking thiazide diuretics, and 34% were taking both thiazides and spironolactone.

For patients on 2, 3, or 4 treatments, there was no statistically significant relationship between use of virtually all of the medications and their doses. The only exception was spironolactone; patients on 2-drug regimens that included spironolactone took an average of 34.8 mg daily of this drug, compared with 29.4 mg for those on 3-drug regimens and 26.8 for those on 4-drug regimens (P < .0001, with 2 treatments as the reference).

Patients were also taking bisoprolol, carvedilol, metoprolol, captopril, enalapril, lisinopril, ramipril, and candesartan.

Dr. Assyag and his colleagues concluded that target dosage and disease management seem to be guiding treatment decisions in these patients, rather than concern about drug toxicity.

"The practitioner should aim at the target dose for each drug," Dr. Assyag said. "The safety of each drug probably does not depend on the number of drugs used."


[Presentation title: The Drug Dosages Are Not Influenced by the Number of Recommended Treatments Prescribed in Chronic Heart Failure: Results of the French Survey IMPACT-RECO. Abstract 532]

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