Relax That Heart

By Christine Gorman

Doctors are doing such a good job of saving the lives of heart-attack victims that a whole new problem has surfaced: many of the survivors are left with severely damaged hearts. That has contributed to an increase in cases of congestive heart failure, an often debilitating condition in which the muscle is too weak to pump enough blood to the rest of the body and eventually exhausts itself. This ailment is growing more common not only because of doctors' success in saving heart-attack patients but also because of other factors, including an aging population. What it all adds up to is that 4.8 million Americans are living diminished lives with weakening hearts. The number of deaths from congestive heart failure has doubled, from 20,000 in 1979 to 44,000 in 1996.

Now comes word of new hope in the form of an old prescription drug. In a study of 2,647 patients in the Jan. 2 issue of Lancet, researchers found that treating folks who have mild to moderate heart failure with medications called beta-blockers lowered their risk of death 34% over 15 months compared to patients who did not take the drugs. A yet unpublished study that was presented last November at a meeting of the American Heart Association reached a similar conclusion.

These results come as a bit of a surprise. Although beta-blockers have been used safely for decades to treat hypertension, chest pain and heart attacks, most physicians believed they were too dangerous to give to patients suffering from congestive heart failure.

Here's why: Beta-blockers counteract the body's fight-or-flight reactions to stress. More specifically, the drugs block the so-called beta-adrenergic receptors--molecules, found in muscles, that respond to surges of adrenaline. The beta-blockers thus relax the heart, causing it to beat more slowly. This seems like the last thing you would want to do for someone whose heart isn't pumping much blood in the first place.

It turns out, however, that much of the damage caused by congestive heart failure occurs when the body overreacts to the chronic lack of blood. It responds by pumping out more and more adrenaline, which forces the ailing heart to work ever harder. Beta-blockers interrupt this destructive cycle, allowing the heart to stabilize.

Researchers hope it won't take too long to convince doctors that they can safely prescribe beta-blockers for congestive heart failure. "Fewer than 5% of these patients are now on beta-blockers," says Dr. Milton Packer, professor of medicine at Columbia-Presbyterian Medical Center in New York City. "But if we could get 75% to 90% of them on the drugs, we'd be saving tens of thousands of lives."

Make no mistake, these are powerful drugs. Side effects can include fatigue, insomnia and, in men, impotence. Physicians must start the patient on low doses to allow the body to adapt to the medication. They must monitor the patient closely, at least in the first few weeks, for signs of overdose. The drugs cannot be taken by people with severe heart failure or asthma. Nor are they appropriate for folks whose heart condition is a result of valve disease. Even certain over-the-counter medications, such as Tagamet, can interfere with their action. But many patients whose lives have been constrained and threatened by congestive heart failure will probably agree that the benefits are worth the risks.

Learn more about congestive heart failure at www.healthfinder.gov/ or amhrt.org/ E-mail Christine at gorman@time.com