Pharmacological trials including patients with more severe heart failure were more likely to show a significant improvement with therapy than trials of milder heart failure .
Using mean values in these trials , the age of patients appeared a more important determinant of 6MWT distance than New York Heart Association classification .
The 6MWT has not yet been proven to be a robust test for the identification of effective pharmacological interventions although it appears useful for the assessment of cardiac resynchronization therapy .
The results of the 6MWT were concordant with changes in symptoms , suggesting that it may be used as supportive evidence for symptom benefit .
AIMS The 6 min walk test ( 6MWT ) is commonly used in clinical trials to assess treatments for heart failure , but its ability to distinguish between effective and ineffective treatments is question able .
The aim of this study is to investigate , using a systematic literature review , the utility of the 6MWT as a measure of the effectiveness of treatment in r and omized controlled trials of heart failure .
Comparison of the effects of losartan and enalapril on clinical status and exercise performance in patients with moderate or severe chronic heart failure.
OBJECTIVES This study assessed the feasibility of an efficacy trial comparing angiotensin-converting enzyme inhibition and angiotensin II receptor antagonism in heart failure . Patients with moderate or severe heart failure whose condition had previously been stabilized by treatment with a converting enzyme inhibitor were r and omly assigned to receive enalapril or losartan . The study was design ed to detect any signs of clinical deterioration during double-blind treatment . BACKGROUND Losartan is a specific , nonpeptide angiotensin II receptor-1 antagonist with a vasodilator hemodynamic profile similar to that of converting enzyme inhibitors . Although therapy with specific receptor blockade has certain theoretic advantages over nonspecific converting enzyme inhibition , demonstration of a comparable therapeutic effect in patients with congestive heart failure will require a major effort comparing two active agents . METHODS One hundred sixty-six patients with stable heart failure in New York Heart Association functional class III or IV and an ejection fraction < or = 35 % were included in a multicenter , double-blind , parallel , enalapril-controlled trial . After a 3-week stabilization period with optimal therapy , including digitalis , diuretic drugs and a converting enzyme inhibitor , patients were r and omly assigned to 8 weeks of therapy with losartan , 25 mg/day ( n = 52 ) ; losartan , 50 mg/day ( n = 56 ) ; or enalapril , 20 mg/day ( n = 58 ) . Patients were assessed with frequent clinical and laboratory evaluation and exercise testing . RESULTS No significant differences between groups in terms of changes in exercise capacity ( 6-min walk test ) , clinical status ( dyspnea-fatigue index ) , neurohumoral activation ( norepinephrine , N-terminal atrial natriuretic factor ) , laboratory evaluation or incidence of adverse experience were observed . CONCLUSIONS The results suggest that losartan and enalapril are of comparable efficacy and tolerability in the short-term treatment of moderate or severe congestive heart failure . A trial design ed to compare the efficacy , tolerability and effect on mortality of long-term angiotensin II receptor blockade with converting enzyme inhibition is both feasible and ethically responsible
Pharmacological trials including patients with more severe heart failure were more likely to show a significant improvement with therapy than trials of milder heart failure .
Using mean values in these trials , the age of patients appeared a more important determinant of 6MWT distance than New York Heart Association classification .
The 6MWT has not yet been proven to be a robust test for the identification of effective pharmacological interventions although it appears useful for the assessment of cardiac resynchronization therapy .
The results of the 6MWT were concordant with changes in symptoms , suggesting that it may be used as supportive evidence for symptom benefit .
AIMS The 6 min walk test ( 6MWT ) is commonly used in clinical trials to assess treatments for heart failure , but its ability to distinguish between effective and ineffective treatments is question able .
The aim of this study is to investigate , using a systematic literature review , the utility of the 6MWT as a measure of the effectiveness of treatment in r and omized controlled trials of heart failure .