Abstract 2743: Improved Survival for Class III Heart Failure after 2000: Impact of Therapies Demonstrated in a Real-life Population
Objective: Implementation of new therapies may delay heart failure (HF) progression, alter the clinical profiles of patients who develop advanced symptoms, and influence survival. We hypothesized that patients presenting with class III HF symptoms in 2002– 03 would demonstrate more severe disease than those presenting in 1997–98.
Methods: Patients newly referred with EF≤30% and NYHA class III symptoms of HF in 1997–98 and 2002– 03 were followed prospectively. Disease duration, therapies at referral, clinical characteristics, laboratory and echocardiographic data were compared. Patients were followed for end points of death or urgent transplantation for a minimum of 18 months.
Results: A total of 143 of 559 patients (26%) from 1997–98 and 73 of 222 patients (33%) from 2002– 03 met the inclusion criteria. Initial prevalence of beta blocker use more than doubled from 27% to 67% by 2002– 03 (p<0.001), median duration of HF prior to referral increased from 2 to 3 years, but there was less LV dilation (LVEDD 68 mm vs. 63 mm in 2002– 03, p=0.004). Contrary to our hypothesis, the degree of clinical compromise, valvular regurgitation, and renal dysfunction associated with class III symptoms was not worse at time of referral. Survival free of death or urgent transplantation was significantly improved from 73% to 85% at 1 year and 66% to 77% at 18 months (p=0.008).
Conclusions: Patients referred with advanced HF now have a higher prevalence of beta blocker use, longer disease duration before symptomatic progression, and less LV remodeling. The clinical profile, valvular regurgitation, and renal dysfunction associated with class III symptoms remained consistent over time. Lower peak VO2 in the recent era is likely attributable to increased beta blocker use. Although EF and peak VO2 were lower in the later era, subsequent event-free survival was significantly higher. Improved survival due to new therapies, namely beta blockers, can be demonstrated in this real-life class III HF population.