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A randomized trial called the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) investigated whether N-terminal brain natriuretic peptide (BNP)-guided heart failure therapy was more effective than symptom-guided therapy. Results suggested that BNP-guided therapy did not result in improved clinical outcomes when compared to symptom-guided therapy.

Long term effect of percutaneous coronary intervention (PCI) in patients with silent ischemia after myocardial infraction was studied in comparison with anti-ischemic drug therapy alone. PCI was found to be more beneficial than optimized drug therapy alone, in reducing long term risk of major cardiac events.

Coronary angioplasty may be better than drug therapy for elderly people with angina pectoris, according to a study of 282 patients. Patient outcomes and mortality rates were similar in patients treated with either angioplasty or drugs. However, patients treated with drugs were more likely to be hospitalized and to require angioplasty.

The article presents a randomized controlled trial which compared brain natriuretic peptide (BNP) therapy versus symptom-guided therapy for treatment of elderly patients with congestive heart failure. 499 patients aged 60 years or older with systolic heart failure, New York Heart Association class II or greater, N-terminal BNP level of two or more times the upper limit of normal, and prior hospitalization for heart failure within one year were included in the study. 18 month survival with no hospitalizations and quality of life were primary outcomes. Researchers found that BNP therapy did not improve overall clinical outcomes or quality of life compared with symptom-guided therapy.

The article presents a response from Hans-Peter Brunner La Rocca, Peter Buser, and Matthias Pfisterer to a letter to the editor discussing their article "BNP-guided vs symptom-guided heart failure therapy: the Trial of Intensified vs. Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) randomized trial," published in a previous issue.

A response by Dr. Paul Erne and colleagues to a letter to the editor concerning their article "Effects of percutaneous coronary interventions in silent ischemia after myocardial infarction: the SWISS II randomized controlled trial" in a previous issue is presented.

Replies to reader comment on research by the author about the outcome of medical and invasive therapy for aged patients with angina. Idea that the issue was quality of life and not mortality in the TIME study.