Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial.

Background: Angiotensin-receptor blockers (ARBs) are effective treatments for patients with heart failure, but the relation between dose and clinical outcomes has not been explored. We compared the effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure.

Methods: This double-blind trial was undertaken in 255 sites in 30 countries.

Transforming health care through the medical home: the example of heart failure.

Amid ongoing legislative efforts to achieve universal coverage and reduce costs while improving quality of care, heart failure represents a major public health problem, challenging us to restructure systems of reimbursement and care. The "medical home" represents the best option for aligning and incentivizing multidisciplinary groups of providers to optimize decision-making for individual patients and the population, at large, and to compete based on quality and cost. For the medical home to meet the needs of patients with heart failure, it must eliminate barriers and facilitate collaboration among specialists, primary care physicians, and other providers.

Design of the heart failure endpoint evaluation of AII-antagonist losartan (HEAAL) study in patients intolerant to ACE-inhibitor.

Background: In patients with heart failure and reduced left ventricular ejection fraction, angiotensin receptor blockers have been found to reduce mortality and morbidity and to prevent or reverse left ventricular remodelling, compared to optimized background treatment. In light of these data, The Heart failure Endpoint evaluation of Angiotensin II Antagonist Losartan (HEAAL) study was developed to determine whether losartan 150 mg is superior to losartan 50 mg (antihypertensive dose) in reducing morbidity and mortality among patients with symptomatic heart failure who are intolerant of angiotensin-converting enzyme (ACE)-inhibitors.

Aims/methods: To compare the effect of high and moderate doses of losartan on the primary endpoint of all-cause mortality and hospitalisation due to heart failure in patients (n = 3834) with symptomatic heart failure and an ejection fraction < or = 40% who are intolerant of ACE-inhibitor treatment.