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 β-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.
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 β-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.
Authors: Kathryn C Chatfield; Genevieve C Sparagna; Carmen C Sucharov; Shelley D Miyamoto; Jonathan E Grudis; Rebecca D Sobus; Jamie Hijmans; Brian L Stauffer Journal: J Mol Cell Cardiol Date: 2014-06-14 Impact factor: 5.000
Authors: John Gierula; Richard M Cubbon; Maria F Paton; Rowenna Byrom; Judith E Lowry; Sarah F Winsor; Melanie McGinlay; Emma Sunley; Emma Pickles; Lorraine C Kearney; Aaron Koshy; Thomas A Slater; Hemant K Chumun; Haqeel A Jamil; Kristian M Bailey; Julian H Barth; Mark T Kearney; Klaus K Witte Journal: Eur Heart J Qual Care Clin Outcomes Date: 2019-07-01
Authors: Paul A Heidenreich; Nancy M Albert; Larry A Allen; David A Bluemke; Javed Butler; Gregg C Fonarow; John S Ikonomidis; Olga Khavjou; Marvin A Konstam; Thomas M Maddox; Graham Nichol; Michael Pham; Ileana L Piña; Justin G Trogdon Journal: Circ Heart Fail Date: 2013-04-24 Impact factor: 8.790
Authors: John C Loh; Julie Creaser; Darlene A Rourke; Nancy Livingston; Tamara K Harrison; Elizabeth Vandenbogaart; Jaime Moriguchi; Michele A Hamilton; Chi-Hong Tseng; Gregg C Fonarow; Tamara B Horwich Journal: Circ Heart Fail Date: 2013-03-11 Impact factor: 8.790
Authors: Bianca C Bernardo; Xiao-Ming Gao; Catherine E Winbanks; Esther J H Boey; Yow Keat Tham; Helen Kiriazis; Paul Gregorevic; Susanna Obad; Sakari Kauppinen; Xiao-Jun Du; Ruby C Y Lin; Julie R McMullen Journal: Proc Natl Acad Sci U S A Date: 2012-10-09 Impact factor: 11.205