Outcome after device implantation in chronic heart failure is dependent on concomitant medical treatment.
BACKGROUND
Device implantation in chronic heart failure (CHF) for cardiac resynchronization therapy (CRT) with or without implantable cardioverter/defibrillator (ICD) is an established treatment option for symptomatic patients under medical baseline therapy. Although recommended, the need for optimization of medical therapy was never proven. As in 'the real world', medical therapy is not always up-titrated to the desirable dosages; this provides the opportunity to evaluate the impact of optimizing medical therapy in patients who had received a device therapy with proven effectiveness.


METHODS
This observational cohort study retrospectively assessed the 'real life'-effect of CRT compared with that of CRT/ICD therapy and the impact of concomitant pharmacotherapy on outcome. Outcome of patients with guideline recommended renin-angiotensin system inhibitor and ss-blocker dosages was compared with that of patients who failed to reach the desired dosages. Mean follow-up for the 205 CHF (95 CRT and 110 CRT/ICD) patients was 16.8 + or - 12.4 months.


RESULTS
In the total study cohort, 83 (41%) reached the combined primary endpoint of all-cause death or cardiac hospitalization [CRT group: 25 (26%), CRT/ICD group: 58 (52.7%), P < 0.001]. Multiple cox regression analysis revealed non-optimized medical therapy at follow-up [HR = 2.080 (1.166-3.710), P = 0.013] and CRT/ICD vs. CRT [HR = 2.504 (1.550-4.045), P < 0.001] as significant predictors of the primary endpoint.


CONCLUSIONS
Our data stress the importance of professional monitoring and titration of pharmacotherapy not only in medically treated CHF patients but also in patients under device therapy by a heart failure unit or a specialized cardiologist.
Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Christopher
C
Adlbrecht
C
C
Adlbrecht
M
M
Hülsmann
M
M
Gwechenberger
G
G
Strunk
C
C
Khazen
F
F
Wiesbauer
M
M
Elhenicky
S
S
Neuhold
T
T
Binder
G
G
Maurer
I M
IM
Lang
R
R
Pacher
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors