Does enoximone improve mortality and quality of life in patients with severe end stage heart failure?
In patients with severe heart failure, enoximone improved quality of life but significantly increased mortality, highlighting the trade-off between symptom relief and survival with inotropic therapy.
OBJECTIVES--To determine the effects of enoximone on mortality and quality of life in patients with severe end stage heart failure. DESIGN--A randomised, double blind, placebo controlled trial of the addition of enoximone to conventional treatment. Planned minimum follow up of one year. SETTING--District general hospitals and cardiological referral centres in the United Kingdom. PATIENTS--Planned 200 patients with severe, symptomatic heart failure despite treatment with diuretics and where appropriate and tolerated angiotensin converting enzyme inhibitors and digoxin. RESULTS--The study was ended early by the ethics committee after 151 patients had been recruited because of an excess mortality in the enoximone group: 27 deaths compared with 18 in the placebo group (P < 0.05). Quality of life measured with a disease specific questionnaire showed a clinically significant improvement at week 2 with a mean increase score of 0.48 in the enoximone treated patients compared with 0.14 in those receiving placebo (P = 0.0086). With the Nottingham health profile questionnaire the physical mobility score was improved after three months in the enoximone group, median 21.3 compared with 41.8 in the placebo group (P = 0.008). CONCLUSIONS--In patients with severe heart failure who remain incapacitated despite conventional treatment enoximone reduced survival but had a beneficial effect on the quality of life. Drugs that improve symptoms in severe end stage heart failure should not be discarded lightly.
Cowley et al. (Thu,) studied this question.