Treating heart failure: the breakthrough of new treatments

If you have heart failure, it will generally get worse without treatment. Chronic heart failure starts with mild symptoms, for example where there is a small amount of damage to the heart muscle following a heart attack. It can get gradually worse over time.

Fortunately, BHF research has shown that treatments given immediately after a heart attack can help limit this long-term damage.

In 1993, BHF Professor Stephen Ball and colleagues at the University of Leeds published the results of a ground-breaking clinical trial, known as the AIRE study. They showed that common medicines called ACE inhibitors (angiotensin-converting enzyme inhibitors), given to patients with signs of heart failure in the days after a heart attack, could save lives. In the trial, they prevented one death for every 18 patients treated. What’s more, the trial proved that ACE inhibitors gave heart attack patients a better chance of recovery with significantly longer survival and better quality of life.

Soon afterwards, in 1995, BHF-funded research by Professor Allan Struthers and his team at the University of Dundee showed for the first time that adding the diuretic (water tablet) spironolactone to ACE inhibitors increased the beneficial effect. These results were later confirmed in a larger international clinical trial that showed that spironolactone reduced death rates in people with heart failure by 30%.

Until the late 1990s, it was thought that another type of drug called beta-blockers should not be used for people with heart failure. This has changed thanks to BHF-funded research by Professor Sian Harding and colleagues at Imperial College London, which showed the benefits of long-term use of beta-blockers in failing human heart cells. These findings were then transferred to patients thanks to several international clinical trials in the early 2000s. Beta blockers are now recommended in all international guidelines for the treatment of chronic heart failure.

Thanks to BHF research, all these groups of drugs are now a vital part of heart failure treatment in the UK and worldwide.

First published 1st June 2021