Prognosis and mechanism of death in treated heart failure: data from the placebo arm of Val-HeFT.

Published

Journal Article

The magnitude of benefit on mortality of combined angiotensin-converting enzyme inhibitor (ACEI) and beta-blocker (BB) therapy for heart failure cannot be reliably assessed from prospective randomized trials of individual drugs with intent-to-treat analysis. The placebo arm of the Valsartan Heart Failure Trial (Val-HeFT) included patients who remained on background therapy with ACEIs, BBs, neither, or both. The outcomes in these four subgroups should provide a better guide to mortality benefit. Overall mortality (mean follow-up, 23 months) was 31.6% in those receiving neither neurohormonal blocker, 29% and 39% lower in those on ACEIs or BBs, respectively, and 62% lower (11.9% mortality) in those receiving both drugs. In the neither neurohormonal inhibitor group, 48% of the heart failure-related deaths were adjudicated as sudden, whereas in the group receiving ACEIs and BBs, 79% of the deaths were sudden, and pump failure mortality was only 1% per year. The combination of ACEIs and BBs exerts a greater mortality reduction than suggested from clinical trials and reduces pump failure mortality to 1% per year.

Full Text

Duke Authors

Cited Authors

  • Cohn, JN; Carson, PE; O'Connor, C; Opasich, C; Piña, IL; Scherillo, M; Sinagra, G; Warner-Stevenson, L; Tristani, FE; Volpi, A

Published Date

  • May 2006

Published In

Volume / Issue

  • 12 / 3

Start / End Page

  • 127 - 131

PubMed ID

  • 16760697

Pubmed Central ID

  • 16760697

International Standard Serial Number (ISSN)

  • 1527-5299

Digital Object Identifier (DOI)

  • 10.1111/j.1527-5299.2006.05441.x

Language

  • eng

Conference Location

  • United States