title: Temporal trends in treatment and outcomes for advanced heart failure with reduced ejection fraction from 1993-2010: findings from a university referral center.
abstract: BACKGROUND
  Randomized trials have demonstrated the efficacy of several new therapies for heart failure (HF) with reduced ejection fraction over the preceding 2 decades. This study investigates whether these therapeutic advances have translated into improvement in outcomes for patients with advanced HF referred to a heart transplant center.
  
  
  RESULTS
  Patients with HF (n=2507) referred to a single university center were analyzed in three 6-year eras during which medical and device therapies were evolving: 1993 to 1998 (era 1), 1999 to 2004 (era 2), and 2005 to 2010 (era 3). Impaired hemodynamics and comorbidities were more frequent at time of referral in later eras, whereas other HF severity parameters where similar or improved. Successive eras had greater usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, aldosterone antagonists, implantable cardioverter defibrillators, and cardiac resynchronization therapy, consistent with evolving evidence and guideline recommendations over the study period. All-cause mortality and sudden death were significantly lower in era 2 and 3 compared with era 1. After multivariable risk adjustment, era 3 had significantly decreased 2- and 3-year all-cause mortality risk and significantly decreased 1- and 3-year sudden death risk compared with era 1. However, progressive HF death and the combined outcome of mortality/urgent transplant/ventricular assist device were modestly increased in the latter eras.
  
  
  CONCLUSIONS
  Over the past 2 decades, patients with advanced HF referred to and managed at a tertiary university referral center have benefited from advances in HF medications and devices, as evidenced by improvements in overall survival and sudden death risk.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Loh
authors.forename: Julie
authors.initials: J
authors.lastname: Creaser
authors.forename: Darlene A
authors.initials: DA
authors.lastname: Rourke
authors.forename: Nancy
authors.initials: N
authors.lastname: Livingston
authors.forename: Tamara K
authors.initials: TK
authors.lastname: Harrison
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Vandenbogaart
authors.forename: Jaime
authors.initials: J
authors.lastname: Moriguchi
authors.forename: Michele A
authors.initials: MA
authors.lastname: Hamilton
authors.forename: Chi-Hong
authors.initials: CH
authors.lastname: Tseng
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Horwich
mesh_terms: D000328:Adult; D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012017:Referral and Consultation; D013318:Stroke Volume
keywords: heart failure; mortality; therapy