Ancillary diagnostic and therapeutic issues in cardiac failure.

A truly important advance in medical science must have practical implications for the patient, eg, rendering diagnosis faster, safer, less distressing, or more accurate. Improvements in noninvasive techniques for hemodynamic monitoring constitute such progress. In other areas of cardiology, such as managing arrhythmias and preventing sudden death in heart failure, little progress is apparent. However, recent studies have at least identified some treatments that are either ineffective or harmful. Finally, alternative solutions, no matter how improbable, should be explored when a problem seems insoluble. Despite the fact that many would like scientific progress to be a series of logical steps, most medical advances are serendipitous or reinventive.