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European Journal of Heart Failure 1999 1(3):251-257; doi:10.1016/S1388-9842(99)00015-X
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© 1999 European Society of Cardiology

Tailored therapy to hemodynamic goals for advanced heart failure

Lynne Warner Stevenson1

Brigham and Women's Hospital, Cardiovascular Division 75 Francis St., Boston, MA 02115, USA

Key Words: Heart failure • Hemodynamics • Vasodilators • Mitral regurgitation

Accepted March 3, 1999

The first 150 words of the full text of this article appear below.


   1. Tailoring to something
 
Our therapies for heart failure are prescribed to address at least one of three goals: survival, quality of life, and prevention of the disease progression that would threaten the first two goals. All therapy is tailored to something, even if it is to a uniform ‘target dose if tolerated’ from a megatrial. It seems unlikely, however, that ‘one size fits all’, many patients perhaps responding best to a dose that is higher or lower, with the absence of side effects being only one aspect of fit. Tremendous energy has been devoted to developing new drugs and ‘winning’ with a mortality or disease progression endpoint. The roster of victorious drugs, however, far outreaches our understanding about how to select and use them for an individual patient.

We lack surrogate endpoints for heart failure that will predict in time whether therapy is likely to improve survival or prevent disease progression. Once heart . . . [Full Text of this Article]


   2. Why not hemodynamics?
 

   3. When should we measure hemodynamics?
 

   4. Current therapy tailored to measured hemodynamics
 

   5. Benefits observed with tailored therapy
 

   6. Beyond hemodynamically tailored therapy
 

   7. Future evolution of tailored therapy
 

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