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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

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.

Regarding the drug efficacy, the authors did not mention the actual scores of the erectile function domain before and after sildenafil and placebo administration. However, inspection of Figure 2 in the article showed that the average score of erectile function improved from approximately 9 at baseline to 16 at . . . [Full Text of this Article]

Nasser Mikhail, MD, MSc

Correspondence: Dr Nasser Mikhail, Endocrinology Division, UCLA School of Medicine, Olive View—UCLA Medical Center, Sylmar, CA 91342-1495 (nasser.mikhail@gte.net)

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RELATED ARTICLE

Use of Sildenafil for Safe Improvement of Erectile Function and Quality of Life in Men With New York Heart Association Classes II and III Congestive Heart Failure: A Prospective, Placebo-Controlled, Double-blind Crossover Trial
Linda J. Webster, Evangelos D. Michelakis, Terry Davis, and Stephen L. Archer
Arch Intern Med. 2004;164(5):514-520.
ABSTRACT | FULL TEXT