About 2. 5 million individuals have congestive heart fai lure in the United States with over 400, 000 new cases expected annually. Congestive heart failure also is one of the commonest causes for hospital admissions accounting for over 5 million hospital days per year. Despite the early recognition of this condition and active medical research into both mechanisms and therapy, prognosis continues to remain dismal wi th less than a 50% expected five year survival. In the last decade we have seen many new medical and therapeutic options for patients with congestive heart failure which extend beyond the use of bed rest, sodium restriction, digitalis and diuretics. These include vasodilators of a variety of types including the angiotensin conventional enzyme (ACE) inhibitors. Also, many new inotropes are under active investigation both in oral and intravenous forms. In March of 1984 a survey of over 5000 physicians was performed under the auspices of the American Heart Association (reported in: JAOC 8:966, 1986). That survey showed that there was no universally accepted defini tion for congestive heart fai lure and that a wide spectrum of diagnostic cri teria for this common condi tion existed even among academic cardiologists. There was no clear standard as to even the mos t bas ic treatment of conges t i ve heart fai lure. For example, exercise restriction was recommended by 19% of physicians, 31% recommended no change in activity, and 50% either light exercise or an exercise conditioning program.
Inhaltsverzeichnis
I Epidemiology, Therapeutic Endpoints. - 1. The public health and clinical implications of the national increase in congestive heart failure. - 2. Therapeutic endpoints in the treatment of congestive heart failure with systolic dysfunction. - 3. Evaluation of ventricular function in patients with heart failure: invasive or noninvasive? . - 4. Assessment of neurohormonal parameters in congestive heart failure: determination of sodium and water regulation. - 5. The assessment of quality of life and exercise response in patients with chronic cardiac failure. - Panel Discussion. - II Preclinical Issues and Pro Arrhythmia Definitions. - 6. Animal models of heart failure. - 7. Electrophysiology in congestive heart failure animal models. - 8. Noninvasive evaluation of proarrhythmia. - 9. Criteria for proarrhythmia in patients with congestive heart failure: use of electrophysiologic testing. - Panel Discussion. - III FDA Endpoint Issues. - 10. Are placebo-controlled trials necessary in the evaluation of new therapeutic agents in severe chronic heart failure? . - 11. What the FDA requires for endpoint measures in congestive heart failure studies. - 12. Design of trials to assess safety and effectiveness in Rx of CHF. - Panel Discussion. - IV Therapeutic Strategies. - 13. How does congestive heart failure alter response to drugs? . - 14 Status of vasodilators for heart failure. - 15. Perspectives on the use of new phosphodiesterase inhibitors in the treatment of chronic cardiac failure. - 16. Is there a role for beta-blockers in heart failure patients? . - Panel Discussion. - V Clinical Trial Issues. - 17. What CHF trials have shown to date and what is needed? . - 18. How to study sudden cardiac death as an endpoint in congestive heart failure trials. - 19. Interpretation of clinical trials in patients with congestive heart failure. - Panel Discussion. - Participants.
