We hear a lot about heart attacks, in which the coronary arteries become blocked, and people have sudden pain in the chest. We hear a lot less about chronic heart failure, in which the heart muscle is not strong enough to pump the blood efficiently round the body. Yet heart failure is just as big a cause of severe illness and deaths as heart attacks.

Maybe the reason for the media's relative lack of interest in heart failure is that it isn't so dramatic as heart attacks. Heart attacks took Eric Morecambe and John Smith from us in their active middle years. Heart failure tends to come up on people more slowly, so that they gradually become invalids.

During that time, most heart failure sufferers retire slowly from their working lives. The main symptoms are slowly worsening breathlessness on exercise, weakness and tiredness most of the time, and, later, swelling of the feet and ankles.

These symptoms are mainly due to retention of fluid (salts and water) in the body, as the heart isn't strong enough to drive the blood forcibly enough through the lungs and kidneys. So for many years, doctors treating patients with heart failure have had to give drugs to strengthen the heart beat and get rid of the extra fluids.

Centuries ago, heart failure was known as dropsy, and was treated quite successfully with plant extracts that did both jobs. Digitalis from foxgloves helped to control and strengthen an erratic heartbeat, and "diuretics" made from dandelions and other plants helped to stimulate the kidneys into expelling fluid.

Today's treatments for heart failure use modern drugs, but they work on the same principles. We have up-to-date diuretics and drugs called "ACE inhibitors" and "calcium antagonists" to help both the heart and the kidneys to work more efficiently. And in certain circumstances, especially when the heart rhythm is dodgy, we still use the modern equivalent of digitalis, digoxin.

However, even now, treating heart failure is tricky. One problem is that it isn't just one illness - it has quite a few different causes.

It can follow a heart attack that has damaged too much heart muscle, or it can be the result of a viral infection of the heart, or it can be due to a "cardiomyopathy", a group of illnesses in which the heart muscle fails from as yet unknown causes. A fair number of cases, sadly, are due to too much alcohol.

So a combination of drugs that may help one patient with heart failure may actually make another one worse.

Until now, there is one group of drugs that doctors have generally fought shy of in heart failure - the beta-blockers. Beta-blockers tend to make the heart beat slower and bring down the blood pressure - and many people with heart failure need their pressures raised, not lowered.

So many GPs like myself were surprised to hear of a trial going on all over Europe, in 2,647 patients with fairly severe heart failure.

It gave everyone in the trial their usual treatment, and added either very small doses of a so-called "selective" betablocker, bisoprolol, or a dummy tablet. The results appeared in the first Lancet of 1999.

There were a third fewer deaths in the patients taking bisoprolol, including a 42 per cent drop in the number of sudden deaths due to heart failure. And a third fewer patients on bisoprolol than on the dummy treatment had to be admitted to hospital during the time of the trial.

This is a great saving in people's lives and in NHS costs - if it were repeated all over the country the hospital bills would fall dramatically and thousands more people would survive to see the millennium.

For me that Lancet article was the first good news piece in 1999. Yet it didn't hit the headlines. Family doctors can't yet use bisoprolol for heart failure in Britain, because it will have to go through all the usual licensing procedures first.

And the first few doses will have to be given with great care to avoid any problems with slowing heart rates and lower blood pressure, so that we will all have to be trained in its use.

The Lancet report is only the start of an avalanche of good news to come this year. There are many more large clinical trials of new drugs in all sorts of illnesses to be reported this year. I'm looking forward to breaking news of these to you.

Converted for the new archive on 30 June 2000. Some images and formatting may have been lost in the conversion.