Document Detail

Long-Term Outcomes in Patients With Ambulatory New York Heart Association Class III and IV Heart Failure Undergoing Cardiac Resynchronization Therapy.
MedLine Citation:
PMID:  25491007     Owner:  NLM     Status:  In-Data-Review    
Patients with ambulatory New York Heart Association (NYHA) class IV heart failure were significantly underrepresented in clinical trials of cardiac resynchronization therapy (CRT). The natural long-term trajectory of survival free of left ventricular assist device (LVAD) or heart transplant in patients with ambulatory class IV symptoms who underwent CRT has not been established. We extracted clinical data on 723 consecutive patients with NYHA class III or ambulatory class IV heart failure, left ventricular ejection fraction ≤35%, and a QRS duration ≥120 ms who underwent CRT from September 30, 2003, to August 6, 2007. Chart notes immediately before CRT were reviewed to confirm NYHA class status before CRT. Kaplan-Meier curves and a multivariate Cox proportional hazards model were constructed to determine long-term survival free of heart transplant and LVAD based on NYHA class status. Of the 723 patients, 52 had ambulatory class IV symptoms. Over a mean follow-up of 5.0 ± 2.5 years controlling for many possible confounders, ambulatory NYHA class IV status was independently associated with poor long-term outcomes. The 1-, 2-, 3-, 4-, and 5-year survival free of LVAD or heart transplant for class III versus ambulatory class IV patients was 92.0%, 84.0%, 75.0%, 68.1%, and 63.2% versus 75.0%, 61.5%, 52.0%, 45%, and 40.4%, respectively. Although patients with ambulatory class IV heart failure receiving CRT have inferior long-term outcomes compared with those with class III symptoms, survival in class IV patients continues to parallel class III patients over an extended follow-up. At 5 years, survival free of LVAD or heart transplant in ambulatory class IV patients receiving CRT is 40%.
John Rickard; Mohammed Bassiouny; Ryan J Tedford; Bryan Baranowski; David Spragg; Daniel Cantillon; Niraj Varma; Bruce L Wilkoff; W H Wilson Tang
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Publication Detail:
Type:  Journal Article     Date:  2014-10-15
Journal Detail:
Title:  The American journal of cardiology     Volume:  115     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2015 Jan 
Date Detail:
Created Date:  2014-12-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  82-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2015 Elsevier Inc. All rights reserved.
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