title: Treatment with higher dosages of heart failure medication is associated with improved outcome following cardiac resynchronization therapy.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) is associated with improved morbidity and mortality in patients with chronic heart failure (CHF) on optimal medical therapy. The impact of CHF medication optimization following CRT, however, has never been comprehensively evaluated. In the current study, we therefore investigated the effect of CHF medication dosage on morbidity and mortality in CHF patients after CRT implantation.
  
  
  RESULTS
  Chronic heart failure medication was assessed in 185 patients after CRT implantation. During an overall mean follow-up of 44.6 months, 83 patients experienced a primary endpoint (death, heart transplantation, assist device implantation, or hospitalization for CHF). Treatment with higher dosages of angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blockers (ARBs) (P = 0.001) and beta-blockers (P < 0.001) as well as with lower dosages of loop diuretics (P < 0.001) was associated with a reduced risk for the primary combined endpoint as well as for all-cause mortality. Echocardiographic super-responders to CRT were treated with higher average dosages of ACE-I/ARBs (68.1 vs. 52.4%, P < 0.01) and beta-blockers (59 vs. 42.2%, P < 0.01). During follow-up, the average dosage of loop diuretics was decreased by 20% in super-responders, but increased by 30% in non-super-responders (P < 0.03).
  
  
  CONCLUSIONS
  The use of higher dosages of neurohormonal blockers and lower dosages of diuretics is associated with reduced morbidity and mortality following CRT implantation. Our data imply a beneficial effect of increasing neurohormonal blockade whenever possible following CRT implantation.
authors.affiliation: Department of Cardiology, University Hospital Zurich, University Heart Center, Rämistrasse 100, 8091 Zurich, Switzerland.
authors.forename: Susann
authors.initials: S
authors.lastname: Schmidt
authors.forename: David
authors.initials: D
authors.lastname: Hürlimann
authors.forename: Christoph T
authors.initials: CT
authors.lastname: Starck
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.forename: Jan
authors.initials: J
authors.lastname: Steffel
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D058406:Cardiac Resynchronization Therapy; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D049994:Sodium Potassium Chloride Symporter Inhibitors
keywords: Cardiac resynchronization therapy; Chronic heart failure; Optimal medical therapy