Long‐term prognostic impact of therapeutic strategies in patients with idiopathic dilated cardiomyopathy: changing mortality over the last 30 years. (14th December 2013)

• Record Type: Journal Article
• Authors: Merlo, Marco; Pivetta, Alberto; Pinamonti, Bruno; Stolfo, Davide; Zecchin, Massimo; Barbati, Giulia; Di Lenarda, Andrea; Sinagra, Gianfranco
• Is Part Of: European journal of heart failure. Volume 16:Number 3(2014)
• Page Start: 317
• Page End: 324
• Publication Date: 2013-12-14
• Subjects: Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.16
• Languages: English
• ISSNs: 1388-9842

Abstract

<abstract abstract-type="main" id="ejhf16-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ejhf16-sec-0001" sec-type="section"> <title>Aims</title> <p id="ejhf16-para-0001">ACE‐inhibitors, β‐blockers, implantable cardioverter–defibrillator (ICD) and cardiac resynchronization therapy (CRT) improved prognosis of heart failure. We sought to analyse the long‐term prognostic impact of evidence‐based integrated therapeutic strategies in patients with idiopathic dilated cardiomyopathy (IDCM).</p> </sec> <sec id="ejhf16-sec-0002" sec-type="section"> <title>Methods and results</title> <p id="ejhf16-para-0002">From 1978 to 2007, 853 IDCM patients (45 ± 15 years, 72% males) were enrolled and classified as follows: Group 1, 110 patients (12.8%) enrolled during 1978–1987; Group 2, 376 patients (44.1%) enrolled during 1988–1997; Group 3, 367 patients (43.1%) enrolled during 1998–2007. ACE‐inhibitors/angiotensin receptor blockers were administered in 34%, 93%, and 93% (<italic>P <</italic>0.001), and β‐blockers in 11%, 82%, and 86% (<italic>P <</italic>0.001) in Groups 1, 2, and 3, respectively; ICDs were implanted in 2%, 14%, and 13% (<italic>P =</italic> 0.005); mean time to device implantation was lower in Group 3. At 8 years, heart transplant (HTx)‐free survival rates were 55%, 71%, and 87% in Groups 1, 2, and 3, respectively (<italic>P <</italic>0.001). Similar progressive improvement was found for pump‐failure death (DHF)/HTx, while survival free from sudden death (SD) was significantly improved only in Group 3. Multivariable models considering competing risk indicated early diagnosis (i.e. a baseline less advanced disease stage) and tailored medical therapy (HR 0.44, CI 95% 0.19–0.98) as independent protectors against DHF/HTx. Concerning SD, lower left ventricular ejection fraction emerged as a predictor, while ICD was the only therapy with a protective role (HR 0.08, CI 95% 0.01–0.61). Treatment with digitalis emerged as a predictor of both DHF/HTx and SD.</p> </sec> <sec id="ejhf16-sec-0003" sec-type="section"> <title>Conclusions</title> <p id="ejhf16-para-0003">An effective management and evidence‐based integrated therapeutic approach progressively and significantly improved the long‐term prognosis of IDCM during the last three decades.</p> </sec> </abstract>