Congestive Heart Failure
Due to Systolic Dysfunction

• Pharmacologic Therapy
• Beta-blockers-in heart failure
• ACE-inhibitors- use maximal dosages in heart failure
• Angiotensin blockers- instead of and as well as ace-inhibitor therapy with beta-blockers
• Spirinolactone in heart failure
• Nitrate and hydralazine combination for African-Americans

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• Prophylactic ICD therapy

Benefits of ISDN and Hydralazine in African-Americans

Re-analysis of the V-HeFT trial had suggested that African-Americans might derive benefit from treatment with nitrates and hydralazine. The A-HeFT trial set out to determine this benefit could be obtained with background therapy with "modern" pharmacological therapy.

The trial enrolled African-Americans with heart failure that were on standard heart failure medications including betablockers, ace-inhibitors or angiotension blockers and diuretics. Entry criteria included:

• NYHA class 3-4 symptoms
• LV ejection fraction less than or equal to 35% or LV ejection fraction less than 40% with LV dilation.

The participants were randomised to receive a fixed-dose combination of ISDN-hydralazine or a placebo.

Initial dose was 20 mg of the nitrate and 37.5 mg of hydralazine three times daily. The dose could be doubled at the discretion of the physician.

The trial was stopped early after a mean follow-up of only ten months when mortality rates were:

• placebo group- 10.2 percent
• treatment group- 6.2 percent.

In other words only 25 patients need to be treated for only ten months to prevent one death.

Hitesh Patel, Cardiologist
12th March, 2005

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