title: Changing characteristics and mode of death associated with chronic heart failure caused by left ventricular systolic dysfunction: a study across therapeutic eras.
abstract: BACKGROUND
  Therapies for patients with chronic heart failure caused by left ventricular systolic dysfunction have advanced substantially over recent decades. The cumulative effect of these therapies on mortality, mode of death, symptoms, and clinical characteristics has yet to be defined.
  
  
  RESULTS
  This study was a comparison of 2 prospective cohort studies of outpatients with chronic heart failure caused by left ventricular systolic dysfunction performed between 1993 and 1995 (historic cohort: n=281) and 2006 and 2009 (contemporary cohort: n=357). In the historic cohort, 83% were prescribed angiotensin-converting enzyme inhibitors and 8.5% were prescribed β-adrenoceptor antagonists, compared with 89% and 80%, respectively, in the contemporary cohort. Mortality rates over the first year of follow-up declined from 12.5% to 7.8% between eras (P=0.04), and sudden death contributed less to contemporary mortality (33.6% versus 12.7%; P<0.001). New York Heart Association class declined between eras (P<0.001). QTc dispersion across the chest leads declined from 85 ms (SD, 2) to 34 ms (SD, 1) and left ventricular end-diastolic dimensions declined from 65 mm (SD, 0.6) to 59 mm (SD, 0.5) (both P<0.001).
  
  
  CONCLUSIONS
  Survival has significantly improved in patients with chronic heart failure caused by left ventricular systolic dysfunction over the past 15 years; furthermore, sudden death makes a much smaller contribution to mortality, and noncardiac mortality is a correspondingly greater contribution. This has been accompanied by an improvement in symptoms and some markers of adverse electric and structural left ventricular remodeling.
authors.affiliation: University of Leeds, Leeds, United Kingdom.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Cubbon
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Gale
authors.forename: Lorraine C
authors.initials: LC
authors.lastname: Kearney
authors.forename: Clyde B
authors.initials: CB
authors.lastname: Schechter
authors.forename: W Paul
authors.initials: WP
authors.lastname: Brooksby
authors.forename: Jim
authors.initials: J
authors.lastname: Nolan
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Adil
authors.initials: A
authors.lastname: Rajwani
authors.forename: Wazir
authors.initials: W
authors.lastname: Baig
authors.forename: David
authors.initials: D
authors.lastname: Groves
authors.forename: Pauline
authors.initials: P
authors.lastname: Barlow
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Fisher
authors.forename: Phillip D
authors.initials: PD
authors.lastname: Batin
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Kahn
authors.forename: Azfar G
authors.initials: AG
authors.lastname: Zaman
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Shah
authors.forename: Jon A
authors.initials: JA
authors.lastname: Byrne
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lindsay
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sapsford
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Wheatcroft
authors.forename: Klaus K
authors.initials: KK
authors.lastname: Witte
authors.forename: Mark T
authors.initials: MT
authors.lastname: Kearney
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D006113:United Kingdom; D018487:Ventricular Dysfunction, Left / Q000150:complications*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors