A pilot study on clinical course of advanced heart failure and role of device therapy
I ChungAbstract
Background
Automatic Implantable Cardioverter defibrillator (AICD) is a class I indication for primary prevention for sudden cardiac death in patients with severe left ventricular dysfunction and class III if life expectancy less than 1 year. The role of device therapy in advanced heart failure patients is less clear. This pilot study aims to assess the clinical course of patients with advanced heart failure and the use of device therapy.
Method
60 patients diagnosed with advanced heart failure, who had to fulfil criteria by Heart Failure Association, were recruited from a teaching hospital. Continuous variables were compared by Student t tests and categorical variables compared by use of the Fisher exact test. Clinical endpoints include cardiovascular death (CVD), hospitalization for heart failure (HHF) were recorded.
Results
Mean age 70 ± 11.75 years, male 73% and younger. Mean age for male and female were 74.38 ± 10.24 and 68.50 ± 11.97 years respectively. Hypertension 83% Diabetes mellitus 50%, atrial fibrillation 42%, previous stroke 17%. Ischaemic etiology 48%. Sacubitrial/ Valsartan 52%, Angiotensin inhibitors/Angiotensin Receptor Blocker 20%, b-blocker 63%, SGLT-2 inhibitor 43%. spironolactone 33%, Ivabradine 20. Mean left ventricular ejection fraction 20 ± 7.34%. HbA1c 6.68 ± 1.55%, low density lipoprotein 2.19 ± 0.96 mmol/L. Creatinine 149.82 ± 51.43 µmol/L. Device therapy 25%. Use of inotrope 38% and levosimendan 31%. Median follow-up duration of 8.50 (4-13) years. Median days from time of advanced heart failure to death 306 (207-614) days. There were 28 CVD, 25 due to pump failure, 2 presented with cardiac arrests, 1 with asystole and pulse electrical activity each, 1 with undetermined death Median number of HHF were 4 (2.25-6) years.
Conclusions
Advanced HF patients have significant mortality and they mostly died from pump failure with median time of 306 days. This pilot study suggests AICD did not improve outcome in these patients and needs to be further validated.