Update on major health topics

HEART FAILURE

Surgery seems to enhance odds of survival more than drugs do.

THE QUESTION: Faced with a heart that cannot effectively pump blood throughout the body, doctors generally recommend either surgery or medication to manage the problem. Do the chances of dying from this problem, known as heart failure, vary by the type of treatment?

THIS STUDY analyzed data on 765 people treated for advanced heart failure; 230 (30 percent) had surgery — most often a bypass or balloon angioplasty — within six months of their diagnosis, and 535 (70 percent) were treated only with drugs. After three years, 34 percent of the people given only drugs had died, compared with 20 percent of those who had had surgery. Taking into consideration factors related to the condition of their hearts at the start of the study, people in the surgery group were calculated to have about half the risk of dying within three years as those whose condition was managed only with medication.

WHO MAY BE AFFECTED BY THESE FINDINGS? People with advanced heart failure. About 5 million people in the United States have this condition, which is responsible for some 300,000 deaths a year. Among people over 65, heart failure is one of the most frequent causes of hospitalization.

CAVEATS: Some people who had surgery also took medication. The study did not determine whether the results varied by the type of surgical procedure.

FIND THIS STUDY: Jan. 17 issue of Circulation; abstract available online at www.circulationaha.org.

Information

Learn more about heart failure: www.nhlbi.nih.gov/health and www.americanheart.org.

ALZHEIMER'S DISEASE

A late-stage drug may also have value for the long term.

THE QUESTION: Sometimes drugs that work for a few weeks or months continue to be effective long-term. Sometimes they don't, or side effects occur. When tested for six months, memantine proved able to slow the progression of symptoms in people with advanced Alzheimer's. Might it continue to help if taken longer?

THIS STUDY involved 175 people with moderate to severe Alzheimer's disease who had been randomly assigned in an earlier study to take memantine (Namenda) or a placebo daily for 24 weeks. For the next 28 weeks, everyone was given the drug. During this time, the 80 people who had switched from taking a placebo to taking memantine showed a slower rate of decline in their ability to perform daily functions and in their scores on cognitive tests than they had shown while taking the placebo. Also, their caregivers rated their behavior as improved. In those who had taken the drug for a year, the slowing of symptoms achieved during the first study was maintained and the medication was well tolerated.

WHO MAY BE AFFECTED BY THESE FINDINGS? People with moderate to severe Alzheimer's. In later stages of the disease, people become increasingly confused and can quickly lose the ability to care for themselves. Nearly 5 million Americans have this disease, a number that is projected to grow to 16 million by 2050.

CAVEATS: The study was funded by Merz Pharmaceuticals GmbH, which markets the drug outside the United States; two of the six authors were its employees.

FIND THIS STUDY: January issue of the Archives of Neurology; abstract available online at www.archneurol.com.

The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment's effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult a physician.