Bloodletting In Congestive Heart Failure

[ironjustice]

Original communication
Further experiences with venesection in congestive heart failure ☆ ☆☆
American Heart Journal
Volume 4, Issue 6, August 1929, Pages 641–645
William S. Middleton, M.D.
Madison, Wis., USA
Available online 10 June 2004

Abstract
In conclusion it may be granted that the immediate results from
venesection of 500 c.c. in congestive heart failure are frequently
spectacular and in a majority of instances, beneficial. From the very
nature of the cases selected for this procedure ultimate recovery is
not anticipated in a high proportion. Nevertheless, a survival of 45.4
per cent is reported in this group and an apparent prolongation of
life claimed in an added 22.7 per cent (5 cases). The application of
such a mechanical therapeutic measure as venesection offers a field of
particular usefulness for venous pressure determinations, in that not
only does venous hypertension constitute an index of right heart load,
but the degree of primary fall in venous pressure on blood-letting and
the curve thereafter serve as excellent prognostic measurements of its
efficiency.

http://dx.doi.org/10.1016/S0002-8703(29)90547-0

From the Department of Medicine, University of Wisconsin.
Read before the Wisconsin Heart Club, April 19, 1929.
Copyright © 1929 Published by Mosby, Inc.

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"This is the largest published study measuring blood volume and
patient
outcomes. Congestive heart failure is the number one cause for
admission to
hospitals for patients over 65 years of age and results in annual
healthcare
costs exceeding $38 billion.
The study followed severely ill congestive heart failure patients for
a median
follow up of 719 days. During the first year, the major finding was a
39% death
rate in patients that were hypervolemic (excess blood volume) vs. 0%
death rate
for those who were normovolemic/hypovolemic (normal blood volume/
mildly reduced
blood volume). For those hypervolemic patients that were followed for
a median
duration of 719 days, the death rate was almost 55% vs. 0% for those
patients
who were normovolemic to slightly hypovolemic."


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