Ger tillägg av ARB till redan pågående behandling med ACE-hämmare hos hjärtsviktspatienter bättre hälso- och kostnadseffekt?

Sammanfattning: Heart failure is a condition where the heart is incapable of providing adequate blood supply to different organs in the body. The underlying causes of heart failure is some kind of disorder in the heart function, and require careful diagnostics. The basic symptoms that arise from heart failure is difficulty in breathing, that aggravate when lying down, and fatigue. The patients’ symptoms and impaired quality of life can be in different stages depending on the severity of the heart failure. Heart failure is a present widespread disease with numerical superiority which is more likely to affect elderly patients. Heart failure is a very expensive condition and causes enormous costs for the society. The basic treatment of heart failure consists of ACE-inhibitors in combination with beta blockers and with additional diuretics. If intolerance occurs with ACE-inhibitors, often in the form of dry cough, then treatment with angiotensin receptor inhibitors (ARB) will be used instead. The aim of the study was to find out if additional treatment with ARB in patients diagnosed with heart failure and receiving basic treatment with ACE-inhibitors lead to better health or had any economic advantage. The method used consists of literature search studies in the Pubmed database. The search gave a total of 103 articles of which six were chosen. The criteria for inclusion was that it should be clinical trials which were not older than 14 years and that the studies should be based on humans. Two of the six studies that were chosen were health economic studies. The studies were randomized, double blind, placebo controlled and included a large number of patients. The results from the studies showed that there were no significant improvements on mortality or morbidity, when additional treatment with ARB was given to heart failure patients already receiving treatment with ACE-inhibitors. A decrease in hospital admission was seen, but at the same time there were more adverse events arising that lead to discontinuation of study treatment. The economic studies showed a higher medical service cost when treatment with ARB was added and the reason for this were that ARB drugs were more expensive than ACE-inhibitors. It is concluded that the additional treatment with ARB in patients diagnosed with heart failure and already receiving treatment with ACE-inhibitors had no favorable effect neither from a health perspective or an economic perspective. However, health economic studies that are made from a society point of view are required to be able to draw definite conclusions regarding the economic part.