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Changing Characteristics and Mode of Death Associated With Chronic Heart Failure Caused by Left Ventricular Systolic Dysfunction A Study Across Therapeutic Eras

Lookup NU author(s): Professor Azfar Zaman

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Abstract

Background-Therapies for patients with chronic heart failure caused by left ventricular systolic dysfunction have advanced substantially over recent decades. The cumulative effect of these therapies on mortality, mode of death, symptoms, and clinical characteristics has yet to be defined. Methods and Results-This study was a comparison of 2 prospective cohort studies of outpatients with chronic heart failure caused by left ventricular systolic dysfunction performed between 1993 and 1995 (historic cohort: n = 281) and 2006 and 2009 (contemporary cohort: n = 357). In the historic cohort, 83% were prescribed angiotensin-converting enzyme inhibitors and 8.5% were prescribed beta-adrenoceptor antagonists, compared with 89% and 80%, respectively, in the contemporary cohort. Mortality rates over the first year of follow-up declined from 12.5% to 7.8% between eras (P = 0.04), and sudden death contributed less to contemporary mortality (33.6% versus 12.7%; P < 0.001). New York Heart Association class declined between eras (P < 0.001). QTc dispersion across the chest leads declined from 85 ms (SD, 2) to 34 ms (SD, 1) and left ventricular end-diastolic dimensions declined from 65 mm (SD, 0.6) to 59 mm (SD, 0.5) (both P < 0.001). Conclusions-Survival has significantly improved in patients with chronic heart failure caused by left ventricular systolic dysfunction over the past 15 years; furthermore, sudden death makes a much smaller contribution to mortality, and noncardiac mortality is a correspondingly greater contribution. This has been accompanied by an improvement in symptoms and some markers of adverse electric and structural left ventricular remodeling. (Circ Heart Fail. 2011; 4: 396-403.)

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Author(s): Cubbon RM, Gale CP, Kearney LC, Schechter CB, Brooksby WP, Nolan J, Fox KAA, Rajwani A, Baig W, Groves D, Barlow P, Fisher AC, Batin PD, Kahn MB, Zaman AG, Shah AM, Byrne JA, Lindsay SJ, Sapsford RJ, Wheatcroft SB, Witte KK, Kearney MT

Publication type: Article

Publication status: Published

Journal: Circulation. Heart Failure

Year: 2011

Volume: 4

Issue: 4

Pages: 396-403

Print publication date: 11/05/2011

ISSN (print): 1941-3289

ISSN (electronic): 1941-3297

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1161/CIRCHEARTFAILURE.110.959882

DOI: 10.1161/CIRCHEARTFAILURE.110.959882

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