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Every summer, with the new cardiology fellows beginning their first year, I prepare talks on the management of chronic and acute heart failure. Many of the basic, fundamental slides remain the same, but increasingly I have to modify them to make room for slides that incorporate new data and new studies.
This raises a series of questions.
Is there value in reviewing the early pivotal studies of ACE inhibitors such as Survival and Ventricular Enlargement (SAVE) and Studies of Left Ventricular Dysfunction (SOLVD), or the early beta-blocker trials such as Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF and those from the United States. Carvedilol Heart Failure Study Group? Should we go over the inclusion and exclusion criteria of these historic studies? The baseline demographics? The precise absolute and risk reductions plus 95% confidence intervals? Subgroups?
The historian part of me answers in the affirmative. The practical side of thinks "everyone knows to use ACE inhibitors, so just provide the view from 30,000 feet."
There are certainly subtleties to the data and clinically relevant questions to ask: What is an ideal dose? Is heart rate a legitimate target for beta-blockers? Are all drugs within the ACE inhibitor or beta-blocker class the same?
I tend to focus on these questions but feel both guilty and wistful when I pass over all the remarkable findings and the historical achievements that the studies represent. But I will have to get over it. Many of our trainees were born some time during the Reagan years. They’re not looking for a history lesson.
So, I won’t be able to SOLVD this problem. I’ll just make certain that the ACE inhibitor is prescribed and move on.
Every summer, with the new cardiology fellows beginning their first year, I prepare talks on the management of chronic and acute heart failure. Many of the basic, fundamental slides remain the same, but increasingly I have to modify them to make room for slides that incorporate new data and new studies.
This raises a series of questions.
Is there value in reviewing the early pivotal studies of ACE inhibitors such as Survival and Ventricular Enlargement (SAVE) and Studies of Left Ventricular Dysfunction (SOLVD), or the early beta-blocker trials such as Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF and those from the United States. Carvedilol Heart Failure Study Group? Should we go over the inclusion and exclusion criteria of these historic studies? The baseline demographics? The precise absolute and risk reductions plus 95% confidence intervals? Subgroups?
The historian part of me answers in the affirmative. The practical side of thinks "everyone knows to use ACE inhibitors, so just provide the view from 30,000 feet."
There are certainly subtleties to the data and clinically relevant questions to ask: What is an ideal dose? Is heart rate a legitimate target for beta-blockers? Are all drugs within the ACE inhibitor or beta-blocker class the same?
I tend to focus on these questions but feel both guilty and wistful when I pass over all the remarkable findings and the historical achievements that the studies represent. But I will have to get over it. Many of our trainees were born some time during the Reagan years. They’re not looking for a history lesson.
So, I won’t be able to SOLVD this problem. I’ll just make certain that the ACE inhibitor is prescribed and move on.
Every summer, with the new cardiology fellows beginning their first year, I prepare talks on the management of chronic and acute heart failure. Many of the basic, fundamental slides remain the same, but increasingly I have to modify them to make room for slides that incorporate new data and new studies.
This raises a series of questions.
Is there value in reviewing the early pivotal studies of ACE inhibitors such as Survival and Ventricular Enlargement (SAVE) and Studies of Left Ventricular Dysfunction (SOLVD), or the early beta-blocker trials such as Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF and those from the United States. Carvedilol Heart Failure Study Group? Should we go over the inclusion and exclusion criteria of these historic studies? The baseline demographics? The precise absolute and risk reductions plus 95% confidence intervals? Subgroups?
The historian part of me answers in the affirmative. The practical side of thinks "everyone knows to use ACE inhibitors, so just provide the view from 30,000 feet."
There are certainly subtleties to the data and clinically relevant questions to ask: What is an ideal dose? Is heart rate a legitimate target for beta-blockers? Are all drugs within the ACE inhibitor or beta-blocker class the same?
I tend to focus on these questions but feel both guilty and wistful when I pass over all the remarkable findings and the historical achievements that the studies represent. But I will have to get over it. Many of our trainees were born some time during the Reagan years. They’re not looking for a history lesson.
So, I won’t be able to SOLVD this problem. I’ll just make certain that the ACE inhibitor is prescribed and move on.
