Chronic Heart Failure: We Are Fighting the Battle, but Are We Winning the War?

Table 1

Reductions in mortality observed in randomized, controlled trials evaluating drug or device therapies in patients with chronic heart failure that were powered for all-cause mortality and resulted in Level of Evidence A recommendations in clinical guidelines.

Treatment	Target population	Mortality relative risk reduction	Trials
ACE inhibitor*	HF with LVEF ≤40%	16–27%	CONSENSUS [65], SOLVD-T [52]
Beta blocker	HF with LVEF ≤40%	34-35%	CIBIS II [61], MERIT-HF [60], COPERNICUS [59]
Mineralocorticoid receptor antagonist	HF with LVEF ≤35%	24–30%	RALES [64], EMPHASIS HF [62]
Implantable cardioverter defibrillator	HF with LVEF ≤30–35% despite optimal drug therapy	23–31%	MADIT-II [79], SCD-HeFT [78]
Cardiac resynchronization therapy ± implantable cardioverter defibrillator	HF with LVEF ≤30–35% with prolonged QRS duration ≥120–130 ms (especially LBBB) despite optimal drug therapy	24–36%	COMPANION [94], CARE-HF [95],; RAFT [92]

∗If the patient is unable to tolerate an ACE inhibitor, an angiotensin receptor blocker may be prescribed. ACE inhibitor: angiotensin converting enzyme inhibitor. HF: heart failure. LVEF: left ventricular ejection fraction. LBBB: left bundle branch block. CONSENSUS: cooperative north scandinavian enalapril survival study. SOLVD-T: studies of left ventricular dysfunction-treatment. CIBIS-II: cardiac insufficiency bisoprolol study II. MERIT-HF: metoprolol CR/XL randomised intervention trial in congestive heart failure. COPERNICUS: carvedilol prospective randomized cumulative survival. RALES: randomized aldactone evaluation study. EMPHASIS HF: eplerenone in mild patients hospitalization and survival study in heart failure. MADIT-II: multicenter automatic defibrillator implantation trial II. SCD-HeFT: sudden cardiac death in heart failure trial (SCD-HeFT). COMPANION: comparison of medical therapy, pacing, and defibrillation in heart failure. CARE-HF: cardiac resynchronization in heart failure study. RAFT: resynchronization/defibrillation for ambulatory heart failure trial.