In a study of people with severe heart failure, those treated early with angioplasty or coronary bypass surgery to improve blood flow to the heart had significantly better survival than those treated with drug therapy.

“It surprised us that the patients who had open-heart surgery or (angioplasty) did so much better,” Dr. Michael S. Lauer, from Case Western Reserve University in Cleveland, Ohio, said in a statement. “Right now the standard care for patients with ... heart failure is medicine.”

The pros and cons of surgery or angioplasty in people with heart failure have been unclear, according to the report in the medical journal Circulation. These treatments can potentially reverse heart dysfunction, but whether this outweighs the risks of surgery and actually improves long-term outcomes is unknown.

Still, there has been evidence that a test that assesses blood flow to the heart can identify patients who would benefit from bypass surgery or angioplasty.

Lauer said the current study is the largest to date to look at whether angioplasty or surgery can improve the survival of patients with severe heart failure. The investigators compared the survival of 153 patients treated with angioplasty or surgery with that of 153 similar patients who received only medical therapy.

During a follow-up period of around 3 years, 84 patients died, the authors report. The 3-year death rate in the angioplasty/surgery group was 15 percent, less than half the 35 percent rate seen in the medical group.

In a related editorial, Dr. Raymond J. Gibbons and colleagues, from the Mayo Clinic College of Medicine in Rochester, Minnesota, commented that although early treatment with angioplasty or surgery “may benefit such patients, their overall outcomes remain relatively poor.”

As such, a major focus should be on preventive efforts, such as counseling patients on healthy lifestyle behaviors and using certain medications, designed to avoid progression to severe heart failure, they add.

SOURCE: Circulation, January 17, 2006.