Doctors' fear of side effects for heart failure treatment is unjustified

November 02, 2000

Safety and costs of initiating angiotensin converting enzyme inhibitors for heart failure in primary care: analysis of individual patient data from studies of left ventricular dysfunction

Editorial: Taking heart failure seriously

Doctors' fear of the side effects associated with drugs to treat heart failure may be a major barrier to their use in general practice, despite strong evidence for their effectiveness, according to a study in this week's BMJ.

Mason and colleagues examined the risks associated with starting treatment in patients with symptoms of heart failure, using data from previous large trials. Over 7000 patients received a test dose of the drug enalapril (an angiotensin converting enzyme inhibitor). Of these, less than 2% reported side effects severe enough to stop treatment. More than 2500 patients were then randomly treated with either enalapril or placebo (a chemically inert substance given in place of a drug). During the first year of treatment, there was no difference in the rates of side effects leading to dose reduction or withdrawal between the enalapril and placebo groups.

These findings show that the introduction of angiotensin converting enzyme inhibitors rarely cause problems, and can be safely started for patients with heart failure in primary care, say the authors. Doctors' perceptions of the risks of these drugs may sometimes be exaggerated, they conclude.

In an accompanying editorial, Cleland and colleagues argue that lack of resources and expertise - not fear of side effects - are the great barriers to efficient treatment of heart failure. "Proper diagnosis and supervision of treatment for Britain's most common malignant disease should not be beyond the resources of our National Health Service," they conclude.

[Paper]: James Mason, Senior Research Fellow, University of York, UK

[Editorial]: Professor John Cleland, Castle Hill Hospital, Kingston upon Hull, UK


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