Showing papers by "Mariell Jessup published in 1990"
TL;DR: A multicenter double-blind, randomized, placebo-controlled trial of oral enoximone, a phosphodiesterase inhibitor, was conducted in 102 outpatients with moderate to moderately severe congestive heart failure and there were no differences between groups in symptoms or exercise duration at the end of 4 months.
Abstract: A multicenter double-blind, randomized, placebo-controlled trial of oral enoximone, a phosphodiesterase inhibitor, was conducted in 102 outpatients (50 receiving enoximone and 52 receiving placebo) with moderate to moderately severe congestive heart failure. All were on a long-term regimen of digoxin and diuretics without vasodilators and converting enzyme inhibitors. Symptom score was obtained, and exercise testing was performed monthly for 4 months. There were no differences between groups in symptoms or exercise duration at the end of 4 months. A subgroup undergoing analysis of oxygen consumption with measurement of anaerobic threshold during exercise showed an increase (p less than 0.05) in anaerobic threshold at 1 month with enoximone. (2.7 +/- 0.8 ml O2/kg/min) compared with placebo (-0.8 +/- 1.2 ml O2/kg/min). This improvement was not sustained at 4 months (0.5 +/- 1.7 ml O2/kg/min with enoximone and 0.2 +/- 1.5 ml O2/kg/min with placebo). The dropout rate was significantly higher (p less than 0.02) with enoximone (46%) than with placebo (25%). Adverse effects other than death were slightly, but not significantly, higher with enoximone (32%) than with placebo (22%). During therapy, five deaths occurred in the enoximone group, and none occurred in the placebo group (p less than 0.05). Two deaths were sudden, two were from progressive congestive heart failure, and one was from acute myocardial infarction. With intention-to-treat analysis and inclusion of patients who were removed from therapy because of lack of study drug effect, 10 deaths occurred in the enoximone group, and three occurred in the placebo group (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
314 citations
TL;DR: The management of patients with congestive heart failure is based upon an understanding of the pathogenetic mechanisms and therapy aimed at optimizing preload, decreasing afterload, and improving contractility can improve symptoms, and in some instances, improve survival.
Abstract: The management of patients with congestive heart failure is based upon an understanding of the pathogenetic mechanisms. Therapy aimed at optimizing preload, decreasing afterload, and improving contractility can improve symptoms, and in some instances, improve survival.
5 citations
TL;DR: Modifications subsequently used include diuretic agents, vasodilators, digitalis, anticoagulants, antiarrhythmics, and possibly beta-blocker therapy, when standard measures fail, potent inotropes and even mechanical assist devices are sometimes necessary.
4 citations
3 citations
01 Jan 1990
TL;DR: Only two compounds have been approved for oral use in chronic heart failure and the chief difficulties have been inability to define the optimal dose and dose interval and assessment of adverse effects and the impact of a drug on the natural course of a fatal disease.
Abstract: Assessing a drug for efficacy and safety in heart failure is a challenging task (Guyatt, 1986). For example, six compounds have been considered by the US Food and Drug Administration (FDA) during the 1980s: captopril, enalapril, amrinone, milrinone, lisinopril and isosorbide dinitrate. However, only two (captopril and enalapril) have been approved for oral use in chronic heart failure. The chief difficulties have been: (1) inability to define the optimal dose and dose interval; (2) inability to demonstrate a statistical superiority over placebo or a comparative agent; and (3) assessment of adverse effects and the impact of a drug on the natural course of a fatal disease (Packer and Leier, 1987).
2 citations