Congestive Heart Failure

1. Front Matter

   Pages i-xiii

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2. Epidemiology, Therapeutic Endpoints

   1. Front Matter

      Pages 1-1

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   2. The Public Health and Clinical Implications of the National Increase in Congestive Heart Failure

      • S. Yusuf, T. Thom, J. Probstfield

      Pages 3-7

   3. Therapeutic Endpoints in the Treatment of Congestive Heart Failure with Systolic Dysfunction

      • E. H. Sonnenblick, T. H. Lejemtel

      Pages 9-16

   4. Evaluation of Ventricular Function in Patients with Heart Failure: Invasive or Noninvasive?

      • Bertram Pitt

      Pages 17-23

   5. Assessment of Neurohormonal Parameters in Congestive Heart Failure: Determination of Sodium and Water Regulation

      • R. J. Cody

      Pages 25-37

   6. The Assessment of Quality of Life and Exercise Response in Patients with Chronic Cardiac Failure

      • Mariell Jessup

      Pages 39-49

3. Back Matter

   Pages 50-67

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4. Preclinical Issues and Proarrhythmia Definitions

   1. Front Matter

      Pages 69-69

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   2. Animal Models of Heart Failure

      • Stewart J. Ehrreich

      Pages 71-96

   3. Electrophysiology in Congestive Heart Failure Animal Models

      • C. William Balke, Joseph F. Spear, E. Neil Moore

      Pages 97-103

   4. Noninvasive Evaluation of Proarrhythmia

      • J. Morganroth

      Pages 105-115

   5. Criteria for Proarrhythmia in Patients with Congestive Heart Failure: Use of Electrophysiologic Testing

      • Leonard N. Horowitz

      Pages 117-130

5. Back Matter

   Pages 131-140

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6. FDA Endpoint Issues

   1. Front Matter

      Pages 141-141

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   2. Are Placebo-Controlled Trials Necessary in the Evaluation of New Therapeutic Agents in Severe Chronic Heart Failure?

      • Milton Packer

      Pages 143-149

   3. What the FDA Requires for Endpoint Measures in Congestive Heart Failure Studies

      • Raymond John Lipicky

      Pages 151-153

   4. Design of Trials to Assess Safety and Effectiveness in Rx of CHF

      • Robert Temple

      Pages 155-170

7. Back Matter

   Pages 171-174

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8. Therapeutic Strategies

   1. Front Matter

      Pages 175-175

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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.

• arrhythmia
• drugs
• electrophysiology
• heart
• heart failure
• physiology
• sudden cardiac death

• Likoff Cardiovascular Institute, Hahnemann University, Philadelphia, USA

  Joel Morganroth

• School of Veterinary Medicine, University of Pennsylvania, Philadelphia, USA

  E. Neil Moore

Policies and ethics