(HealthDay News) – Advances in medications and medical devices have improved overall survival and risk of sudden death over the past two decades for patients with advanced heart failure, according to a study published in the May issue of Circulation: Heart Failure.
John C. Loh, from the University of California Los Angeles, and colleagues analyzed data from patients with heart failure (2,507) referred to a single university center. Patients were analyzed in three six-year eras, during which time medical and device therapies were evolving: 1993–1998 (era 1), 1999–2004 (era 2), and 2005–2010 (era 3).
The researchers found that, during the later eras, impaired hemodynamics and comorbidities were more frequent at time of referral, whereas other heart failure severity parameters where similar or improved. There was greater usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, aldosterone antagonists, implantable cardioverter defibrillators, and cardiac resynchronization therapy in successive eras, consistent with evolving evidence and guideline recommendations over the study period. There was significantly less all-cause mortality and sudden death in era 2 and 3, compared with era 1. After comparing for other risk variables, there was significantly decreased two- and three-year all-cause mortality risk and significantly decreased one- and three-year sudden death risk in era 3 compared with era 1. However, there were modest increases in the later eras in progressive heart failure death and the combined outcome of mortality/urgent transplant/ventricular assist device.
“Over the past two decades, patients with advanced heart failure referred to and managed at a tertiary university referral center have benefited from advances in heart failure medications and devices, as evidenced by improvements in overall survival and sudden death risk,” the authors write.
One author disclosed financial ties to the medical device and pharmaceutical industries.