I disagree with Webster et al1 in concluding that sildenafil citrate is an effective and safe treatment of erectile dysfunction (ED) in patients with New York Heart Association (NYHA) classes II and III congestive heart failure (CHF). I believe this conclusion is premature owing to several limitations in the study.1 The number of patients was limited (n = 35), and the duration of follow-up was short, with only 6 weeks of active drug therapy. Moreover, only the 50-mg dose of sildenafil citrate was assessed. Therefore, the finding that sildenafil use was not associated with adverse effects1 should be interpreted with caution.
Mikhail N. Efficacy and Safety of Sildenafil in Patients With Congestive Heart Failure. Arch Intern Med. 2004;164(18):. doi:10.1001/archinte.164.18.2067-b