Prognosis and mechanism of death in treated heart failure: data from the placebo arm of Val-HeFT.

Jay N. Cohn, Peter E. Carson, Christopher O'Connor, Cristina Opasich, Ileana L. Piña, Marino Scherillo, Gianfranco Sinagra, Lynne Warner-Stevenson, Felix E. Tristani, Alberto Volpi

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


The magnitude of benefit on mortality of combined angiotensin-converting enzyme inhibitor (ACEI) and beta-blocker (BB) therapy for heart failure cannot be reliably assessed from prospective randomized trials of individual drugs with intent-to-treat analysis. The placebo arm of the Valsartan Heart Failure Trial (Val-HeFT) included patients who remained on background therapy with ACEIs, BBs, neither, or both. The outcomes in these four subgroups should provide a better guide to mortality benefit. Overall mortality (mean follow-up, 23 months) was 31.6% in those receiving neither neurohormonal blocker, 29% and 39% lower in those on ACEIs or BBs, respectively, and 62% lower (11.9% mortality) in those receiving both drugs. In the neither neurohormonal inhibitor group, 48% of the heart failure-related deaths were adjudicated as sudden, whereas in the group receiving ACEIs and BBs, 79% of the deaths were sudden, and pump failure mortality was only 1% per year. The combination of ACEIs and BBs exerts a greater mortality reduction than suggested from clinical trials and reduces pump failure mortality to 1% per year.

Original languageEnglish (US)
Pages (from-to)127-131
Number of pages5
JournalCongestive heart failure (Greenwich, Conn.)
Issue number3
StatePublished - 2006
Externally publishedYes

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


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