Benefits of implantable cardiac defibrillators in heart failure are confirmed
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《英国医生杂志》
New York
Implantable cardiac defibrillators significantly reduce mortality in patients with heart failure and impaired left ventricular function, a new study shows.
Dr Gust Bardy of the Seattle Institute for Cardiac Research, Washington, reported the study to the conference.
The sudden cardiac death in heart failure trial (SCD-HeFT) was a randomised controlled trial of an implantable cardiac defibrillator in addition to standard treatment. It reduced mortality by 23% in a five year study of 2521 patients at 148 centres in the United States, Canada, and New Zealand Most patients (77%) were men; the median age was 60, and the median follow-up period was 45.5 months. Patients had class 2 or 3 heart failure according to the New York Heart Association classification and a left ventricular ejection fraction of 35% or less. Most patients were being treated with more than one drug: 85% were taking angiotensin converting enzyme inhibitors, 70% digoxin, 69% blockers, 56% aspirin, 38% statins, 34% warfarin, and 14% angiotensin II receptor blockers.
Patients were randomised to their present treatment with placebo, present treatment with amiodarone, or present treatment with an implantable cardiac defibrillator. The study was double blind with respect to the drug treatments.
After three years the death rate among the patients with defibrillators was 17.1%, compared with 22.3% in patients receiving placebo and 24% in patients receiving amiodarone, said Dr Kerry Lee, associate professor of biostatistics at Duke University in North Carolina, who headed the trial's data coordinating centre.
After five years the death rate was 28.9% in the defibrillator group, 34.1% in the amiodarone group, and 35.8% in the placebo group, he said.
The study was sponsored by the National Heart, Lung, and Blood Institute. Medtronic supplied the defibrillators and Wyeth Pharmaceutical supplied the amiodarone and the placebo pills.
The authors concluded their study by saying: "The present study shows us once again the dismal prognosis of patients with reduced left ventricular function and/or symptomatic heart failure.
"The failure of amiodarone to improve survival of these patients is also discouraging, whereas the use of a simple shock-only device confirmed the profound effect on survival reported in all the previous ICD trials, with the important addendum that the benefit is also conferred in patients with nonischaemic cardiomyopathy." (See News Extra at bmj.com>)(Janice Hopkins Tanne)
Implantable cardiac defibrillators significantly reduce mortality in patients with heart failure and impaired left ventricular function, a new study shows.
Dr Gust Bardy of the Seattle Institute for Cardiac Research, Washington, reported the study to the conference.
The sudden cardiac death in heart failure trial (SCD-HeFT) was a randomised controlled trial of an implantable cardiac defibrillator in addition to standard treatment. It reduced mortality by 23% in a five year study of 2521 patients at 148 centres in the United States, Canada, and New Zealand Most patients (77%) were men; the median age was 60, and the median follow-up period was 45.5 months. Patients had class 2 or 3 heart failure according to the New York Heart Association classification and a left ventricular ejection fraction of 35% or less. Most patients were being treated with more than one drug: 85% were taking angiotensin converting enzyme inhibitors, 70% digoxin, 69% blockers, 56% aspirin, 38% statins, 34% warfarin, and 14% angiotensin II receptor blockers.
Patients were randomised to their present treatment with placebo, present treatment with amiodarone, or present treatment with an implantable cardiac defibrillator. The study was double blind with respect to the drug treatments.
After three years the death rate among the patients with defibrillators was 17.1%, compared with 22.3% in patients receiving placebo and 24% in patients receiving amiodarone, said Dr Kerry Lee, associate professor of biostatistics at Duke University in North Carolina, who headed the trial's data coordinating centre.
After five years the death rate was 28.9% in the defibrillator group, 34.1% in the amiodarone group, and 35.8% in the placebo group, he said.
The study was sponsored by the National Heart, Lung, and Blood Institute. Medtronic supplied the defibrillators and Wyeth Pharmaceutical supplied the amiodarone and the placebo pills.
The authors concluded their study by saying: "The present study shows us once again the dismal prognosis of patients with reduced left ventricular function and/or symptomatic heart failure.
"The failure of amiodarone to improve survival of these patients is also discouraging, whereas the use of a simple shock-only device confirmed the profound effect on survival reported in all the previous ICD trials, with the important addendum that the benefit is also conferred in patients with nonischaemic cardiomyopathy." (See News Extra at bmj.com>)(Janice Hopkins Tanne)