Different causes of heart failure need different treatment strategies

No one would now believe that all infections will respond to a single antib iotic, nor that all known antibiotics should be given to all patients with infection. It is obvious that some patients with specific causes of heart f ailure need specific treatment, but whether heart failure of ischaemic or n onischaemic origin need different treatments is not certain. Only when para llel clinical trials have been conducted with individual drugs in separate groups of patients with ischaemic or nonischaemic heart failure will the ne ed for different treatment strategies be known. Until then, there will be a dependency on second-rank evidence (that which can be derived from trials with 'surrogate' end-points, from meta-analysis of small trials and from su bset analysis of different patient groups within single trials). The best e vidence at present comes from subset analysis of two studies, with bisoprol ol (Cardiac Insufficiency Bisoprolol Study; CIBIS) and amlodipine (Prospect ive Randomised Amlodipine Survival Evaluation; PRAISE). These suggest that patients with different causes of heart failure respond to treatment in dif ferent ways.