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Mortality in two recent reports of clinical trials on patients with congestive heart failure compared with mortality

R B Singer

    Journal of Insurance Medicine (New York, N.Y.)
    |August 18, 2005
    PubMed

    Insights

    Spironolactone reduced excess mortality in congestive heart failure (CHF) patients. Dofetilide did not significantly reduce mortality in patients with atrial fibrillation (AF), with higher excess death rates observed in severe CHF cases.

    Area of Science:

    • Cardiology
    • Pharmacology
    • Medical Statistics

    Background:

    • Previous clinical trials on drug treatment for congestive heart failure (CHF) mortality were reported in the Journal of Insurance Medicine.
    • This study presents results from two recent clinical trials and compares them with prior findings.

    Purpose of the Study:

    • To evaluate the effectiveness of Spironolactone and Dofetilide in reducing mortality in congestive heart failure (CHF) patients.
    • To compare the excess death rates (EDRs) between drug treatment groups and placebo groups.
    • To analyze the impact of CHF severity on mortality rates.

    Main Methods:

    • Conducted two international multicenter clinical trials comparing drug treatments (Spironolactone, Dofetilide) against placebo.
    • Measured excess mortality using excess death rates (EDRs) per 1000 per year.
    • Classified patient severity using the New York Heart Association (NYHA) classification.

    Main Results:

    • Spironolactone reduced EDR from 195 to 139 per 1000 per year.
    • Dofetilide showed no significant reduction in EDR for atrial fibrillation (AF) patients (224 placebo vs. 216 Dofetilide).
    • Higher EDRs were observed in both studies due to a greater proportion of severe CHF patients; EDR increased progressively with NYHA class (173 class 2, 237 class 3, 392 class 4).

    Conclusions:

    • Excess mortality in symptomatic CHF is significant and may exceed individual life insurance limits.
    • Findings suggest potential utility for underwriting structured settlement annuities for CHF patients.
    • Drug efficacy varies, with Spironolactone showing a mortality benefit while Dofetilide did not significantly impact AF-related mortality in this CHF cohort.
    Abstract

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