TY - JOUR
T1 - Prognosis and mechanism of death in treated heart failure
T2 - data from the placebo arm of Val-HeFT.
AU - Cohn, Jay N.
AU - Carson, Peter E.
AU - O'Connor, Christopher
AU - Opasich, Cristina
AU - Piña, Ileana L.
AU - Scherillo, Marino
AU - Sinagra, Gianfranco
AU - Warner-Stevenson, Lynne
AU - Tristani, Felix E.
AU - Volpi, Alberto
PY - 2006
Y1 - 2006
N2 - 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.
AB - 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.
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U2 - 10.1111/j.1527-5299.2006.05441.x
DO - 10.1111/j.1527-5299.2006.05441.x
M3 - Article
C2 - 16760697
AN - SCOPUS:33746058333
SN - 1527-5299
VL - 12
SP - 127
EP - 131
JO - Congestive heart failure (Greenwich, Conn.)
JF - Congestive heart failure (Greenwich, Conn.)
IS - 3
ER -