"In all evils which admit a remedy, impatience should be avoided"

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Physicians, being the ‘fixers’ that they are, are interested in discovering cure-alls for the various disease states. The 18th Century British author and linguistic genius Samuel Johnson reminds us that the path to such remedies often require pain-staking process, and therefore, patience. With heart failure, no single device or drug seems to have the capability to provide a potential cure-all for this debilitating and potentially fatal condition. As a result, questions abound about how to manage these patients, in lieu of a more immediate remedy.

This week, new clinical guidelines emerged from multiple societies to assist providers in managing advanced heart failure patients, including those who will receive a transplant. Specifically, the guidelines recommend a multidisciplinary approach to reduce hospital readmissions, as well as having a specialist to perform heart transplantation.

For managing patients in their homes, the TRUST trial found that home monitoring with automatic daily surveillance can offer safe, early detection of cardiac events in patients with ICDs, compared with standard follow-up methods. The researchers also found that automatic patient monitoring can reduce in-office visits by 45 percent.

In assessing costs for heart failure management, an economic substudy of HF-ACTION found that the cost of exercise training was relatively low for the healthcare system, but patients incurred significant time costs.

The CHARM trial, published in the European Journal of Heart Failure, suggests that bronchodilator use is a “powerful independent predictor” of worsening heart failure and increased mortality in a “broad spectrum” of patients with heart failure.

Fortunately, the research continues to be of interest to industry and government funders. The National Institutes of Health granted Acorda Therapeutics a $1 million grant to fund research surrounding its Glial Growth Factor 2, an investigational agent used to treat heart failure.

Ideally, all the time and effort expended to properly treat and manage this disease state will meet with improved outcomes. As Johnson, who undertook the feat of publishing a dictionary, noted: “Great works are performed not by strength, but by perseverance.”

On these topics, or any others, please feel free to contact me.

Justine Cadet