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Heart failure management using implantable devices for ventricular resynchronization: Comparison of Medical Therapy,
M R Bristow1, A M Feldman, L A Saxon
1Department of Cardiology, University of Colorado, Denver 80262, USA.
Insights
Implantable devices like cardiac resynchronization therapy (CRT) can improve outcomes for chronic heart failure (CHF) patients. These therapies, alongside medication, reduce mortality and hospitalizations, enhancing quality of life.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Chronic heart failure (CHF) is a progressive condition with significant morbidity and mortality despite pharmacological treatments.
- New therapies are needed to decrease mortality, alleviate symptoms, and improve functional capacity in CHF patients.
- Implantable devices for ventricular resynchronization show promise as an adjunct therapy for CHF.
Purpose of the Study:
- To evaluate the efficacy of ventricular resynchronization therapy (VRT) and VRT with cardioverter-defibrillator capability compared to optimal pharmacological therapy alone in CHF patients.
- To assess the impact of these therapies on combined all-cause mortality and hospitalizations.
- To determine improvements in cardiac morbidity, functional capacity, cardiac performance, and quality of life.
Main Methods:
- The Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure (COMPANION) trial was a randomized, open-label, 3-arm study.
- Included patients had New York Heart Association class III or IV CHF, ejection fraction ≤35%, and QRS duration ≤120 milliseconds.
- Compared optimal pharmacological therapy alone versus optimal pharmacological therapy plus VRT or VRT with cardioverter-defibrillator capability.
Main Results:
- Results are not detailed in the provided abstract.
- Further analysis of the COMPANION trial data is required to ascertain specific outcomes.
- The study design allows for the assessment of mortality, hospitalizations, and functional improvements.
Conclusions:
- The COMPANION trial investigates the potential benefits of cardiac resynchronization therapy in managing chronic heart failure.
- Findings are anticipated to guide treatment strategies for CHF patients with specific ejection fraction and QRS duration criteria.
- The study aims to establish whether device therapy offers superior outcomes compared to pharmacological management alone.
Background:
Although pharmacological therapy has ameliorated symptoms and improved the survival of patients with chronic heart failure (CHF), this chronic syndrome remains a progressive disease causing incremental morbidity and early mortality. A new therapy for the treatment of CHF should ideally decrease mortality, alleviate symptoms, and improve functional capacity. A growing body of evidence suggests that the use of implantable devices to resynchronize ventricular contraction may be a beneficial adjunct in the treatment of CHF.
Methods:
The Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure (COMPANION) trial is a randomized, open-label, 3-arm study of patients in New York Heart Association class III or IV with an ejection fraction of 35% or less and a QRS duration of 120 milliseconds or less. The COMPANION study objectives are to determine whether optimal pharmacological therapy used with (1) ventricular resynchronization therapy alone or (2) ventricular resynchronization therapy combined with cardioverter-defibrillator capability is superior to optimal pharmacological therapy alone in reducing combined all-cause mortality and hospitalizations; reducing cardiac morbidity; improving functional capacity, cardiac performance, and quality of life; and increasing total survival.