[Effect of the optimal neurohormonal blockade on long-term survival in patients with chronic heart failure].
BACKGROUND
In recent years large scale clinical trials have cleary shown that a number of pharmacological treatments can improve the outcomes of patients (pts) with chronic heart failure (CHF).


OBJECTIVE
The aim of this study was to assess the effect of optimal neurohormal blockade in pts with chronic heart failure on survival during 12 month follow-up.


METHODS
We analyzed data on 489 pts in NYHA II-IV class of HF, referred to our Dept. (mean age was 69 +/- 12). We define doptimal neurohormonal therapy as beta-blocker and ACE-inhibitor in pts with NYHA II, and beta-blocker, ACE-Inhibitor and spironolactone in patients with NYHA III-IV class. Pts were divided into groups: group 1--optimal neurohormonal blockade (n = 232, mean age, 67 +/- 11), group 2--non-optimal neurohormonal blockade (n = 257, mean age, 70 +/- 13). Pts were followed for 12 month.


RESULTS
Group with optimal therapy were frequent male gender, of ischemic aetiology, and NYHA class II (p < 0.05). Diabetes mellitus, hypertension, left ventricular ejection fraction did not differ the groups (p = NS). Pts with non-optimal therapy were more frequent with prior history of renal dysfunction and anemia at admission (p < 0.05). During 12 month follow-up 12% in optimal vs 40% in non-optimal therapy died (p < 0.005). The rehospitalisation rate during one-year was also significantly higher in pts receiving non-optimal therapy (69% vs 48%, p < 0.005). Cox multivariate analysis showed after adjusting for age, gender, etiology of HF, NYHA functional class, renal dysfunction, EF, had significantly 62% reduction in mortality and 41% reduction in cardiovascular rehospitalisation in pts receiving optimal therapy.


CONCLUSIONS
The optimal neurohormonal therapy have favorable effects on outcomes in pts with CHF. This data strongly support that optimalization of care and evidence-based treatment of CHF pts can improve poor prognosis in this group.
Roik
Marek
M
I Katedra i Klinika Kardiologii IWL Akademii Medycznej w Warszawie. mfroik@amwaw.edu.pl
Starczewska
Małgorzata H
MH
Stawicki
Sławomir
S
Huczek
Zenon
Z
Kochanowski
Janusz
J
Oreziak
Artur
A
Furmańczyk
Agnieszka
A
Opolski
Grzegorz
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013148:Spironolactone / Q000627:therapeutic use*; D015996:Survival Rate; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D013148:Spironolactone