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Is there another way of treating Heart Failure?

People with mild or moderate heart failure got good news yesterday: Studies show a Pfizer drug and a device from Medtronic can boost survival rates and cut trips to the hospital by those who have trouble breathing. But another drug, Johnson & Johnson’s Natrecor, did little to help those with severe heart failure. “It’s hard to tell now which patients should get the pricey medicine, said Dr. Alfred Bove, past president of the American College of Cardiology. All three studies, presented at an American Heart Association conference, are expected to have an immediate effect on care.

Inspra, made by Pfizer is already used for advanced heart failure. In a study of more than 2,700 people with milder symptoms, it cut the risk of death or hospitalization by 37 percent. After nearly two years, fewer than 13 percent of those on Inspra had died of heart problems, versus fewer than 16 percent of those given dummy pills.

“This has the potential of changing the guidelines,’’ said Dr. Mariell Jessup, who heads the heart failure program at the University of Pennsylvania.

Many doctors saw an alternative: wider use of an older relative of Inspra, spironolactone, a generic medicine that costs less than 20 cents a day, versus about $133 a month for Inspra.

The other good news came from a test of an implanted heart device made by Medtronic Inc. Many people with severe heart failure have defibrillators to zap their hearts if they suffer a rhythm problem. Newer combination devices also control how blood moves through the heart. Defibrillators cost $20,000 to $25,000; the combinations are $5,000 to $7,000 more.

The study tested them in 1,800 Canadian patients with mild to moderate heart failure. More than three years later, 40 percent of those with simple defibrillators had died or been hospitalized for heart failure, versus 33 percent of those with combo devices.

The bad news came from a test of Natrecor for shortness of breath. One of six people hospitalized with heart failure were given Natrecor until 2005, when studies suggested it raised the risk of kidney problems. In tests involving more than 7,000 patients, Natrecor, made by Scios Inc., made no difference in rates of hospitalization or death in the following month and only modestly relieved shortness of breath within 6 hours of its infusion.

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