title: Comparison of survival by allocation to medical therapy, surgery, or heart transplantation for ischemic advanced heart failure.
abstract: BACKGROUND
  To ascertain survival of ischemic advanced heart failure patients by treatment allocation, we examined the outcome of transplant assessment patients allocated to medical therapy, high-risk conventional surgery, or transplantation.
  
  
  METHODS
  Patients were identified from the Papworth transplant database and excluded if primary etiology was not ischemic. Grouping was undertaken according to treatment allocation at initial assessment, and analysis was performed by intention to treat. Survival was computed from the time of assessment and Cox regression used to stratify patients according risk with the Heart Failure Survival Score.
  
  
  RESULTS
  From May 1993 to September 2001, a total of 755 patients were admitted for transplant assessment, with 348 (46.1%) identified as having heart failure of ischemic origin. Variables required for calculation of the Heart Failure Survival Score was available in 273 patients (78.4%), and 20 patients (7.3%) were lost to follow-up. Of the remaining 253 patients, 89 (35.2%) were allocated to medical therapy, 32 (12.6%) to surgery, and 132 (52.2%) to transplantation. The relative risk (95% confidence limit) of death compared with medical therapy was 0.62 (0.28, 1.40) for surgery and 0.38 (0.24, 0.61) for transplantation in medium- to high-risk patients. For low-risk patients, the relative risks for death compared with medical therapy were 1.87 (0.63, 5.60) for surgery and 1.97 (0.79, 4.96) for transplantation.
  
  
  CONCLUSIONS
  Transplantation improved survival of medium- and high-risk patients compared with medical therapy. In the low-risk group, this was not evident. However, repeated assessment of risk is required because the hazard for death rises steadily after the third year in these patients.
authors.affiliation: Transplant Unit, Papworth Hospital, Cambridge, UK.
authors.forename: Eric
authors.initials: E
authors.lastname: Lim
authors.forename: Ziad
authors.initials: Z
authors.lastname: Ali
authors.forename: Ayyaz
authors.initials: A
authors.lastname: Ali
authors.forename: Reza
authors.initials: R
authors.lastname: Motalleb-Zadeh
authors.forename: Christopher
authors.initials: C
authors.lastname: Jackson
authors.forename: Seok Ling
authors.initials: SL
authors.lastname: Ong
authors.forename: James
authors.initials: J
authors.lastname: Halstead
authors.forename: Linda
authors.initials: L
authors.lastname: Sharples
authors.forename: Jayan
authors.initials: J
authors.lastname: Parameshwar
authors.forename: John
authors.initials: J
authors.lastname: Wallwork
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Large
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis; D018579:Patient Selection; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D002316:Cardiotonic Agents