Heart failure treatments - Issues of safety versus issues of quality of life

Congestive heart failure is an important cause of morbidity and mortality i n western countries. The profound impact that congestive heart failure has on life expectancy and quality of life has been a continuous stimulus for t he development of new drugs for the treatment of this condition. Despite fa vourable effects on (aspects of) quality of life in short term studies, sev eral of these new agents have been shown to reduce survival in mortality tr ials. However, patients with severe congestive heart failure may experience such incapacitating symptoms that the question should be raised as to whether an improvement in quality of life makes the increased risk of mortality assoc iated with these new agents acceptable. Drugs which improve quality of life at the expense of an increased risk of mortality can be of value in the tr eatment of patients with severe congestive heart failure. However, this is only the case if the probability of improvement in quality of life and prol ongation of life expectancy for those using the drug exceeds the probabilit y of improvement in quality of life and prolongation of life expectancy for those not using the drug. Unfortunately most clinical trials in which both mortality and quality of life are evaluated fail to provide information on this composite probability. Despite disappointing results of some recent mortality trials on new pharma cological treatments of congestive heart failure, sound and well designed c linical trials on innovative heart failure treatments in which these compos ite probabilities are also assessed should be carried out.