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Treatment with higher dosages of heart failure medication is associated with improved outcome following cardiac resynchronization therapy

Schmidt, Susann ; Hürlimann, David ; Starck, Christoph T. ; Hindricks, Gerhard ; Lüscher, Thomas F. ; Ruschitzka, Frank ; Steffel, Jan

In: European Heart Journal, 2014, vol. 35, no. 16, p. 1051-1060

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    Titre
    • Treatment with higher dosages of heart failure medication is associated with improved outcome following cardiac resynchronization therapy
    Auteur
    • Schmidt, Susann. Department of Cardiology, University Hospital Zurich, University Heart Center, Rämistrasse 100, 8091 Zurich, Switzerland
    • Hürlimann, David. Department of Cardiology, University Hospital Zurich, University Heart Center, Rämistrasse 100, 8091 Zurich, Switzerland
    • Starck, Christoph T.. Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
    • Hindricks, Gerhard. Heart Center, University Hospital Leipzig, Leipzig, Germany
    • Lüscher, Thomas F.. Department of Cardiology, University Hospital Zurich, University Heart Center, Rämistrasse 100, 8091 Zurich, Switzerland
    • Ruschitzka, Frank. Department of Cardiology, University Hospital Zurich, University Heart Center, Rämistrasse 100, 8091 Zurich, Switzerland
    • Steffel, Jan. Department of Cardiology, University Hospital Zurich, University Heart Center, Rämistrasse 100, 8091 Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Heart Journal, 2014, vol. 35, no. 16, p. 1051-1060. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:304213
    Summary
    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. Methods and 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). Conclusion 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