For people with dilated cardiomyopathy whose symptoms and cardiac function have recovered, there has been some degree of doubt as to the best approach to drug treatment. British researchers have now completed a randomised trial to examine the effect of phased withdrawal of heart failure medications in patients with previous dilated cardiomyopathy who were now asymptomatic, whose left ventricular ejection fraction (LVEF) had improved from less than 40% to 50% or greater, whose left ventricular end-diastolic volume (LVEDV) had normalised, and who had an N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) concentration less than 250 ng/L. After 6 months, those who continued treatment had treatment withdrawn by the same method. The primary endpoint was a relapse of dilated cardiomyopathy within 6 months
44% of patients randomly assigned to treatment withdrawal met the primary endpoint of relapse compared with none of those assigned to continue treatment. No deaths were reported in either group and three serious adverse events were reported in the treatment withdrawal group: hospital admissions for non-cardiac chest pain, sepsis, and an elective procedure. The researchers conclude that until robust predictors of relapse are defined, drug treatment should continue indefinitely. View more details here