Editorial articles

The pharmacological treatment of patients with chronic
heart failure has changed dramatically over the past 25
years. This change began with the demonstration of
the beneficial effects of the combination of hydralazine and
isosorbide dinitrate in the V-HeFT-I (Veterans Administration
Co-operative Study) trial.

The benefits of transradial coronary intervention (TRI)
over transfemoral (TFI) are becoming increasingly
recognised. In the United Kingdom, an increasing
number of interventions are being performed by the radial
approach and courses supporting this approach are now well
developed.

The success of the 3-hydroxy-3-methylglutaryl-coenzyme
A reductase inhibitors (statins) in ameliorating
atherothrombotic events is firmly established. Large
randomised controlled clinical trials have consistently (and
unequivocally) demonstrated a beneficial role in reducing
coronary events and total mortality in patients with advanced
coronary artery disease (CAD).

Most treatments administered to patients act to relieve symptoms. But in the name of saving life,
having an implanted cardioverter defibrillator (ICD) leaves the patient prone to unpredictable episodes of
symptoms including collapse, and abrupt and explosive chest pain, of which the informed patient may live in
persistent fear.

Despite many attempts at reform, there has been a persistent
shortfall in the number of consultant cardiologists.
As long ago as 1985, the conservative recommendation
was made that each general hospital should have
at least one physician, practising general medicine but
having a special expertise and training in cardiology.

Statins are currently provided at NHS expense for patients
with coronary heart disease (CHD), diabetes and those
whose coronary risk is greater than 3% per year.

The difficulty in delivering a viable primary prevention
policy has been evident ever since the publication of
the National Service Framework for Coronary Heart
Disease (NSF-CHD).

The measurement of biochemical markers of myocardial cell damage is a key component of modern cardiology practice. The use of these tests in the diagnosis of myocardial infarction (MI) has been routine for three decades, with the measurement of serum levels of creatine kinase (CK) and its myocardial band isofraction (CK-MB) emerging as the traditional standard in this respect.

In this issue of Acute and Interventional Cardiology there is a commissioned editorial about the release of cardiac enzymes after percutaneous coronary intervention (PCI). This remains a contentious area and attracts the views of two opposing schools of thought.

The management of advanced heart failure when medical treatment alone is no longer sufficient was the focus of the 2003 British Society for Heart Failure (BSH) annual autumn meeting, held in Oxford on 28 November.