Reducing mortality with device therapy in heart failure patients without ventricular arrhythmias.
Use of device therapy to prevent sudden cardiac death in patients with heart failure is expanding on the basis of evidence from recent clinical trials. Three multicenter prospective clinical trials-Sudden Cardiac Death in Heart Failure (SCD-HeFT); Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION); and Cardiac Resynchronization-Heart Failure (CARE-HF)-were conducted to determine the effectiveness of devices in reducing mortality in patients with heart failure who did not have a history of ventricular arrhythmias. The 3 trials varied in the devices used, the population of patients included, and the study designs. In SCD-HeFT, implantable cardioverter defibrillators were more effective than pharmacological therapy in preventing mortality among patients with mild to moderate heart failure. In COMPANION, cardiac resynchronization therapy alone and cardiac resynchronization therapy plus an implantable cardioverter defibrillator were more effective than optimal drug treatment in reducing morbidity and all-cause mortality in patients with moderate to severe heart failure. In CARE-HF, cardiac resynchronization therapy alone was more effective than optimal drug treatment in reducing all-cause mortality in patients with moderate to severe heart failure. No direct comparison of the devices used has been done. These 3 clinical trials provide clear evidence that device therapy is beneficial for some patients with heart failure, even patients who do not have a history of ventricular arrhythmia.
Chapa
Deborah W
DW
Florida Gulf Coast University, Fort Myers, Florida, USA.
Lee
Hyeon-Joo
HJ
Kao
Chi-Wen
CW
Friedmann
Erika
E
Thomas
Sue A
SA
Anderson
Jill
J
Bardy
Gust H
GH
D002317:Cardiovascular Agents / Q000627:therapeutic use; D003422:Critical Care; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D024802:Nurse's Role; D010138:Pacemaker, Artificial; D010353:Patient Education as Topic; D016032:Randomized Controlled Trials as Topic
D002317:Cardiovascular Agents