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Improving Survival Rates of Patients with Idiopathic Dilated Cardiomyopathy in Tuscany over Three Decades: Impact of Evidence-based Management.
MedLine Citation:
PMID:  23888044     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Contemporary therapeutic options have led to substantial improvement in survival of heart failure (HF) patients. However, limited evidence is available specifically regarding idiopathic dilated cardiomyopathy (IDCM). We thus examined changes in prognosis of a large IDCM cohort systematically followed over the last thirty years.
METHODS AND RESULTS: -From 1977 to 2011, 603 consecutive patients (age=53±12 years, 73%=male, LV ejection fraction=32±10%) fulfilling WHO criteria for IDCM, including negative coronary angiography, were followed for 8.8±6.3 years. Patients were subdivided in four enrollment periods based on HF treatment "eras": 1) 1977-1984(n=66); 2) 1985-1990(n=102); 3) 1991-2000(n=197); 4) 2001-2011(n=238). Rates of patients receiving ACEI/ARBs, beta-blockers and devices at final evaluation increased from 56%, 12%, 8% (period 1) to 97%, 86%, 17% (period 4), respectively (p<0.05). There was a trend towards enrollment of older patients with less severe LV dilatation and dysfunction over the years. During follow-up, 271 patients (45%) reached a combined end-point including death (HF-related, n=142; sudden death, n=71; non-cardiac, n=22) or cardiac transplant (n=36). A more recent enrollment period represented the most powerful independent predictor of favorable outcome [period 2 vs 1 (HR=0.64; p=0.04), period 3 vs 1 (HR=0.35; p<0.001), period 4 vs 1 (HR=0.14; p<001)]. Each period was associated with a 42% risk reduction vs the previous one (HR=0.58, 95%CI=0.50-0.67, p<0.001), reflecting marked decreases in HF-related mortality and sudden death (period 4 vs 1: HR=0.10; p<001, HR=0.13; p<0.0001, respectively).
CONCLUSIONS: -Evidence-based treatment has led to dramatic improvement in the prognosis of IDCM over the last three decades. The benefits of controlled randomized trials can be replicated in the real world, emphasizing the importance of tailored follow-up and long-term continuity of care.
Authors:
Gabriele Castelli; Alessandra Fornaro; Mauro Ciaccheri; Alberto Dolara; Vito Troiani; Benedetta Tomberli; Iacopo Olivotto; Gian Franco Gensini
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-7-25
Journal Detail:
Title:  Circulation. Heart failure     Volume:  -     ISSN:  1941-3297     ISO Abbreviation:  Circ Heart Fail     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-7-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479941     Medline TA:  Circ Heart Fail     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Careggi University Hospital, Florence, Italy.
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