Changing characteristics and mode of death associated with chronic heart failure caused by left ventricular systolic dysfunction a study across therapeutic eras

Richard M. Cubbon, Christopher P. Gale, Lorraine C. Kearney, Clyde B. Schechter, W. Paul Brooksby, Jim Nolan, Keith A A Fox, Adil Rajwani, Wazir Baig, David Groves, Pauline Barlow, Anthony C. Fisher, Phillip D. Batin, Matthew B. Kahn, Azfar G. Zaman, Ajay M. Shah, Jon A. Byrne, Steven J. Lindsay, Robert J. Sapsford, Stephen B. WheatcroftKlaus K. Witte, Mark T. Kearney

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

Background-Therapies for patients with chronic heart failure caused by left ventricular systolic dysfunction have advanced substantially over recent decades. The cumulative effect of these therapies on mortality, mode of death, symptoms, and clinical characteristics has yet to be defined. Methods and Results-This study was a comparison of 2 prospective cohort studies of outpatients with chronic heart failure caused by left ventricular systolic dysfunction performed between 1993 and 1995 (historic cohort: n=281) and 2006 and 2009 (contemporary cohort: n=357). In the historic cohort, 83% were prescribed angiotensin-converting enzyme inhibitors and 8.5% were prescribed β-adrenoceptor antagonists, compared with 89% and 80%, respectively, in the contemporary cohort. Mortality rates over the first year of follow-up declined from 12.5% to 7.8% between eras (P<0.04), and sudden death contributed less to contemporary mortality (33.6% versus 12.7%; P<0.001). New York Heart Association class declined between eras (P<0.001). QTc dispersion across the chest leads declined from 85 ms (SD, 2) to 34 ms (SD, 1) and left ventricular end-diastolic dimensions declined from 65 mm (SD, 0.6) to 59 mm (SD, 0.5) (both P-0.001). Conclusions-Survival has significantly improved in patients with chronic heart failure caused by left ventricular systolic dysfunction over the past 15 years; furthermore, sudden death makes a much smaller contribution to mortality, and noncardiac mortality is a correspondingly greater contribution. This has been accompanied by an improvement in symptoms and some markers of adverse electric and structural left ventricular remodeling. (Circ Heart Fail. 2011;4: 396-403.).

Original languageEnglish (US)
Pages (from-to)396-403
Number of pages8
JournalCirculation: Heart Failure
Volume4
Issue number4
DOIs
StatePublished - Jul 2011

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Left Ventricular Dysfunction
Heart Failure
Mortality
Sudden Death
Therapeutics
Ventricular Remodeling
Angiotensin-Converting Enzyme Inhibitors
Adrenergic Receptors
Cohort Studies
Outpatients
Thorax
Prospective Studies
Survival

Keywords

  • Chronic heart failure
  • Morbidity
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Changing characteristics and mode of death associated with chronic heart failure caused by left ventricular systolic dysfunction a study across therapeutic eras. / Cubbon, Richard M.; Gale, Christopher P.; Kearney, Lorraine C.; Schechter, Clyde B.; Brooksby, W. Paul; Nolan, Jim; Fox, Keith A A; Rajwani, Adil; Baig, Wazir; Groves, David; Barlow, Pauline; Fisher, Anthony C.; Batin, Phillip D.; Kahn, Matthew B.; Zaman, Azfar G.; Shah, Ajay M.; Byrne, Jon A.; Lindsay, Steven J.; Sapsford, Robert J.; Wheatcroft, Stephen B.; Witte, Klaus K.; Kearney, Mark T.

In: Circulation: Heart Failure, Vol. 4, No. 4, 07.2011, p. 396-403.

Research output: Contribution to journalArticle

Cubbon, RM, Gale, CP, Kearney, LC, Schechter, CB, Brooksby, WP, Nolan, J, Fox, KAA, Rajwani, A, Baig, W, Groves, D, Barlow, P, Fisher, AC, Batin, PD, Kahn, MB, Zaman, AG, Shah, AM, Byrne, JA, Lindsay, SJ, Sapsford, RJ, Wheatcroft, SB, Witte, KK & Kearney, MT 2011, 'Changing characteristics and mode of death associated with chronic heart failure caused by left ventricular systolic dysfunction a study across therapeutic eras', Circulation: Heart Failure, vol. 4, no. 4, pp. 396-403. https://doi.org/10.1161/CIRCHEARTFAILURE.110.959882
Cubbon, Richard M. ; Gale, Christopher P. ; Kearney, Lorraine C. ; Schechter, Clyde B. ; Brooksby, W. Paul ; Nolan, Jim ; Fox, Keith A A ; Rajwani, Adil ; Baig, Wazir ; Groves, David ; Barlow, Pauline ; Fisher, Anthony C. ; Batin, Phillip D. ; Kahn, Matthew B. ; Zaman, Azfar G. ; Shah, Ajay M. ; Byrne, Jon A. ; Lindsay, Steven J. ; Sapsford, Robert J. ; Wheatcroft, Stephen B. ; Witte, Klaus K. ; Kearney, Mark T. / Changing characteristics and mode of death associated with chronic heart failure caused by left ventricular systolic dysfunction a study across therapeutic eras. In: Circulation: Heart Failure. 2011 ; Vol. 4, No. 4. pp. 396-403.
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abstract = "Background-Therapies for patients with chronic heart failure caused by left ventricular systolic dysfunction have advanced substantially over recent decades. The cumulative effect of these therapies on mortality, mode of death, symptoms, and clinical characteristics has yet to be defined. Methods and Results-This study was a comparison of 2 prospective cohort studies of outpatients with chronic heart failure caused by left ventricular systolic dysfunction performed between 1993 and 1995 (historic cohort: n=281) and 2006 and 2009 (contemporary cohort: n=357). In the historic cohort, 83{\%} were prescribed angiotensin-converting enzyme inhibitors and 8.5{\%} were prescribed β-adrenoceptor antagonists, compared with 89{\%} and 80{\%}, respectively, in the contemporary cohort. Mortality rates over the first year of follow-up declined from 12.5{\%} to 7.8{\%} between eras (P<0.04), and sudden death contributed less to contemporary mortality (33.6{\%} versus 12.7{\%}; P<0.001). New York Heart Association class declined between eras (P<0.001). QTc dispersion across the chest leads declined from 85 ms (SD, 2) to 34 ms (SD, 1) and left ventricular end-diastolic dimensions declined from 65 mm (SD, 0.6) to 59 mm (SD, 0.5) (both P-0.001). Conclusions-Survival has significantly improved in patients with chronic heart failure caused by left ventricular systolic dysfunction over the past 15 years; furthermore, sudden death makes a much smaller contribution to mortality, and noncardiac mortality is a correspondingly greater contribution. This has been accompanied by an improvement in symptoms and some markers of adverse electric and structural left ventricular remodeling. (Circ Heart Fail. 2011;4: 396-403.).",
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T1 - Changing characteristics and mode of death associated with chronic heart failure caused by left ventricular systolic dysfunction a study across therapeutic eras

AU - Cubbon, Richard M.

AU - Gale, Christopher P.

AU - Kearney, Lorraine C.

AU - Schechter, Clyde B.

AU - Brooksby, W. Paul

AU - Nolan, Jim

AU - Fox, Keith A A

AU - Rajwani, Adil

AU - Baig, Wazir

AU - Groves, David

AU - Barlow, Pauline

AU - Fisher, Anthony C.

AU - Batin, Phillip D.

AU - Kahn, Matthew B.

AU - Zaman, Azfar G.

AU - Shah, Ajay M.

AU - Byrne, Jon A.

AU - Lindsay, Steven J.

AU - Sapsford, Robert J.

AU - Wheatcroft, Stephen B.

AU - Witte, Klaus K.

AU - Kearney, Mark T.

PY - 2011/7

Y1 - 2011/7

N2 - Background-Therapies for patients with chronic heart failure caused by left ventricular systolic dysfunction have advanced substantially over recent decades. The cumulative effect of these therapies on mortality, mode of death, symptoms, and clinical characteristics has yet to be defined. Methods and Results-This study was a comparison of 2 prospective cohort studies of outpatients with chronic heart failure caused by left ventricular systolic dysfunction performed between 1993 and 1995 (historic cohort: n=281) and 2006 and 2009 (contemporary cohort: n=357). In the historic cohort, 83% were prescribed angiotensin-converting enzyme inhibitors and 8.5% were prescribed β-adrenoceptor antagonists, compared with 89% and 80%, respectively, in the contemporary cohort. Mortality rates over the first year of follow-up declined from 12.5% to 7.8% between eras (P<0.04), and sudden death contributed less to contemporary mortality (33.6% versus 12.7%; P<0.001). New York Heart Association class declined between eras (P<0.001). QTc dispersion across the chest leads declined from 85 ms (SD, 2) to 34 ms (SD, 1) and left ventricular end-diastolic dimensions declined from 65 mm (SD, 0.6) to 59 mm (SD, 0.5) (both P-0.001). Conclusions-Survival has significantly improved in patients with chronic heart failure caused by left ventricular systolic dysfunction over the past 15 years; furthermore, sudden death makes a much smaller contribution to mortality, and noncardiac mortality is a correspondingly greater contribution. This has been accompanied by an improvement in symptoms and some markers of adverse electric and structural left ventricular remodeling. (Circ Heart Fail. 2011;4: 396-403.).

AB - Background-Therapies for patients with chronic heart failure caused by left ventricular systolic dysfunction have advanced substantially over recent decades. The cumulative effect of these therapies on mortality, mode of death, symptoms, and clinical characteristics has yet to be defined. Methods and Results-This study was a comparison of 2 prospective cohort studies of outpatients with chronic heart failure caused by left ventricular systolic dysfunction performed between 1993 and 1995 (historic cohort: n=281) and 2006 and 2009 (contemporary cohort: n=357). In the historic cohort, 83% were prescribed angiotensin-converting enzyme inhibitors and 8.5% were prescribed β-adrenoceptor antagonists, compared with 89% and 80%, respectively, in the contemporary cohort. Mortality rates over the first year of follow-up declined from 12.5% to 7.8% between eras (P<0.04), and sudden death contributed less to contemporary mortality (33.6% versus 12.7%; P<0.001). New York Heart Association class declined between eras (P<0.001). QTc dispersion across the chest leads declined from 85 ms (SD, 2) to 34 ms (SD, 1) and left ventricular end-diastolic dimensions declined from 65 mm (SD, 0.6) to 59 mm (SD, 0.5) (both P-0.001). Conclusions-Survival has significantly improved in patients with chronic heart failure caused by left ventricular systolic dysfunction over the past 15 years; furthermore, sudden death makes a much smaller contribution to mortality, and noncardiac mortality is a correspondingly greater contribution. This has been accompanied by an improvement in symptoms and some markers of adverse electric and structural left ventricular remodeling. (Circ Heart Fail. 2011;4: 396-403.).

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KW - Morbidity

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