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Congestive cardiac failure is a common condition, which has now reached epidemic proportions. In the UK it affects between 1% and 3% of the general population 1, 2 and increases with age to affect 10% of those over 70. 2 This represents only those patients who are symptomatic, in a recent population based study in England it was shown that the prevalence of left ventricular (LV) systolic dysfunction (defined as an ejection fraction (EF) <40%) in patients aged 45 years and above was 1.8%, and of these 47% had no symptoms. 1 As the population ages and survival from ischaemic heart disease improves the prevalence is likely to increase further. In a simulation model it was shown that between 1985 and 2010 there is likely to be a 70% increase in absolute numbers of heart failure patients. 3 In the past decade there have been many important advances in the pharmacological treatment of heart failure, however the condition continues to exact a heavy burden in terms of mortality and morbidity. 4 Death attributable to heart failure may be sudden (usually arrhythmic) or attributable to progressive heart failure 5 with gradual deterioration in symptoms. The one year mortality has been shown to increase with worsening symptomatic heart failure. This was 5%-15% for NYHA class II, 20%-50% for class III, and >50% for class IV. 6- 8 The five year mortality after the diagnosis of heart failure remains about 50%. 9- 11 In the UK heart failure has been reported to consume more than 2.5% of the total healthcare expenditure. 2 With such continued impact from heart failure we require new modes of treatment in addition to those currently available to improve mortality and morbidity.
MEDICAL TREATMENTS
Pharmacological treatment for heart failure is described in the NICE guidelines 12 and is designed to improve symptoms and reduce mortality. In heart failure there is overexpression of components of the renin-angiotensin-aldosterone and sympathetic nervous systems. This has been shown to suppress myocardial function, cause myocardial hypertrophy and myocyte apoptosis leading to mural thinning and progressive dilatation. 13 Therefore modulation of these neurohormonal changes has become the cornerstone of treatment. Three main classes of drugs have been shown to improve mortality and symptoms namely drugs affecting the renin-angiotensin system...