title: Most Heart Failure Patients Die from Pump Failure: Implications for Therapy.
abstract: Careful review of the literature of the last 20 years since the appearance of the first positive trials in heart failure indicates an evolution in the mode of death moving from sudden death to a predominance of pump failure death (i.e., death due to progression of heart failure). Pump failure is becoming a leading cause of mortality in a range of patient profiles, including patients with newly diagnosed or severe heart failure, patients with devices, and patients with heart failure associated with Chagas' disease. Indeed, the evidence suggests that modern management strategies, such as beta-blockers and devices, are successful in preventing sudden death. However, this means that optimally treated patients are at greater risk for the consequences of pump failure (death, hospitalization, and reduced quality of life). This highlights a new important unmet need in heart failure, and a priority for current research should be therapies that reduce pump failure death and hospitalization for more cost-effective management of the disease. Insofar as one-third of heart failure patients do not survive more than 3 years after diagnosis, properly addressing pump failure is an essential target in heart failure.
authors.affiliation: Prevention and Rehabilitation Service, Heart Institute (InCor), University of São Paulo Medical School, Dr Enéas de Carvalho Aguiar Avenue, 44, 05403-900, São Paulo, São Paulo, Brazil. pereira.barretto@incor.usp.br.
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Pereira-Barretto
authors.affiliation: Cardiopulmonary Transplantation Service, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
authors.affiliation: Clinical Cardiology Service, Pedro Ernesto University Hospital, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: Denilson Campos
authors.initials: DC
authors.lastname: de Albuquerque
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy; D002423:Cause of Death; D002986:Clinical Trials as Topic; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D064887:Observational Studies as Topic; D011788:Quality of Life; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists