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NEW YORK, Mar 12 (Reuters Health) - A certain type of drug that is used only cautiously in patients with congestive heart failure may be safe for a subset of patients, according to a study by the company that makes the drug.
It seems that the drug, known as dofetilide, can benefit some patients depending on their results on an electrocardiogram (EKG), a measure of the heart's electrical activity.
Congestive heart failure (CHF) is a life-threatening condition in which the heart becomes enlarged and pumps inefficiently, causing fatigue, breathlessness and fluid retention in the limbs and lungs. Dofetilide treatment aims to prevent dangerous irregular heart rhythms called arrhythmias from developing, but in some patients, the drug can actually cause life-threatening arrhythmias, according to a report in the Circulation: A Journal of the American Heart Association. Dofetilide is one of several antiarrhythmic drugs used for this purpose.
Before now, it was impossible to predict which effect would predominate in a given patient, according to Dr. Bente Brendorp from Copenhagen University Hospital in Hellerup, Denmark and associates. In fact, they write, "No other study has addressed the issue."
In the study, the researchers found that patients with a certain abnormality on the EKG--known as a prolonged QTc interval--were at greater risk of dying during the study if they took dofetilide. Those without the prolonged QTc interval benefited from the drug, and were less likely to die during an 18 month period than patients taking a placebo, or inactive drug.
The study included more than 700 patients at 34 hospitals. The influence of QTc interval on the risk of death held true even after the investigators made adjustments for sex, age, smoking, high blood pressure and other factors known to affect the survival of heart failure patients.
"If our results are confirmed in a separate trial, this would be the first time an antiarrhythmic drug shows a clear beneficial effect regarding mortality in patients with CHF," Brendorp told Reuters Health. "For CHF patients with normal QTc intervals, mortality could then be significantly reduced with the prescription of dofetilide."
SOURCE: Circulation 2001;103.
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