title: Adjustments of heart failure medication after implantation of a cardiac resynchronization therapy defibrillator.
abstract: OBJECTIVE
  "Optimal" medical therapy is mandatory before implantation of a cardiac resynchronization therapy (CRT) device, but "optimal" is not further specified. We determined the number of patients on a specific drug, the percentages of recommended target doses of the drugs the patients were on and their evolution over time.
  
  
  METHODS
  Drug therapy (ACE-inhibitors (ACE-I), AT-receptor antagonists (ARBs), betablockers) of 140 patients with a follow-up of at least one year was studied. Response to CRT was defined as reduction in NYHA class ≥1.
  
  
  RESULTS
  Age was 66±9 years, follow-up 43±25 months during which 28 patients (20%) had died. At baseline, 81 % of patients were on a betablocker compared to 95% after 3 years (P-value 0.02). Percentages of target doses were 55±34% and increased to 68±41% after 3 years (P-value <0.02). Percentages were increased in responders (58±40% to 72±32%, P-value 0.01 after 3 years), but not in non-responders (57±31% to 56±38%). At baseline, 97% of patients were on ACE-Is/ARBs and 100% after 3 years. Mean percentages of target doses were 78±43% at implant and between 73±40% and 79±49% during follow-up. Percentages were stable both in responders (83% at implant, 78% after 3 years) and in non-responders (80%/87%, both P-value n.s.).
  
  
  CONCLUSIONS
  Even though quantity and quality of drug therapy at baseline was on an acceptable (betablockers) or high (ACE-Is/ARBs) level, physicians must be very observant on therapy during long-term follow-up, especially on target doses of betablockers in non-responders.
authors.affiliation: Department of Cardiology, University of Basel Hospital, Basel, Switzerland. bschaer@uhbs.ch
authors.forename: L
authors.initials: L
authors.lastname: Hitz
authors.forename: M S
authors.initials: MS
authors.lastname: Kühne
authors.forename: C
authors.initials: C
authors.lastname: Sticherling
authors.forename: S
authors.initials: S
authors.lastname: Osswald
authors.forename: B A
authors.initials: BA
authors.lastname: Schaer
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D057911:Angiotensin Receptor Antagonists