Mortality, reduction

Sin DD, Man SEP (2006) Pharmacotherapy for mortality reduction in chronic obstructive pulmonary disease. Proc Am Thorac Soc 3 624-629... 

DINAMIT (NEJM 2004) ICD vs no ICD in patients with recent MI (6-40 days), EF < 35% and impaired cardiac autonomic function 674 30 No difference in all cause mortality reduction = 0.66... 

The more recent use of aggressive medical therapy with beta blockers, ACE-inhibitors, aspirin, and HMG Co A reductase inhibitors has had a profound benefit on those with coronary artery disease and reduced LVEF. To that end, revascularization still plays an important role in mortality reduction. In the Studies of Left Ventricular Dysfunction (SOLVD) database, CABG does improve survival compared to more modern use of medical therapy, with a 25% mortality risk reduction as well as an intriguing 46% risk reduction of sudden death [91]. This benefit improved as LVEF decreased, thus providing evidence that revascularization may stabilize heart function, reduce abnormal remodeling, and thus reduce the propensity to arrhythmogenicity. 

Base statin seiection on iipid-lowering prowess, cost, side effects, and avaiiabiiity of mortality reduction studies... 

Linxianb (China) 50 5.2 29,584 M-F No reduction of esophageal cancer, reduction of cancer mortality, reduction of cerebrovascular disease only in man (182,183)... 

COPERNICUS (30) NYHA III-IV LVE < 35% 2289 Carvedilol, 25-mg twice/day, vs. placebo Significant reduction of mortality reduction of 24% of composite end points in mortality and rehospitalization... 

Val-HeFT (43) NYHA ll-IV LVEF < 0.40 LV dilatation 5010 Valsartan, 160 mg twice/day, vs. placebo No reduction in overall mortality reduction of composite end point and number of hospitalization... 

Ogunyankin KO, Singh BN. Mortality reduction by anti-adrenergic modulation of arrhythmogenic substrate significance of combining beta blockers and amiodarone. Am J Cardiol 1999 84(9A) R76-82. 

Wilcox RG, von der Lippe G, Olsson CG, Jensen G, Skene AM, Hampton JR. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet 1988 2(8610) 525-30. 

Zeymer et al.80 ESCAMI Enaporide administration as early reperfiision therapy in patients with AMI 1411 Infarct size, mortality Reduction in infarct size after 72 h in patients with AMI<30 min. Trend towards excess death due to stroke in enaporide group... 

The studies of supplementation have drawn attention to peripheral effects, such as the beneficial consequences of DHA in reducing cardiovascular mortality, reduction of immune and inflammatory responses, and influences in the management of diabetes. Supplementation effects also continue to be studied in order to better delineate complex behavioral patterns, with some critical insight on aggression, as but one example, in human studies. 

States those approved for use in heart failure are summarized in Table 14-8. The major differences in the ACE inhibitors are notin their pharmacologic properties but in their pharmacokinetic properties. Although it appears that mortality reduction with ACE inhibitors is probably a drug class effect, not all ACE inhibitors EDA approved for treatment of heart failure have been tested for their effects on mortality in heart failure. Thus it seems most prudent to use those agents which have been documented to prolong survival because the dose required for this effect has been documented. Table 14-8 also contains a summary of the target doses for survival benefit. 

There also has been much debate about whether carvedilol is superior to metoprolol or bisoprolol and whether immediate-release metoprolol has equivalent efficacy to metoprolol CR/XL, the formulation studied in the MERIT-HF trial. Despite the differing properties of carvedilol versus metoprolol or bisoprolol, the clinical trials data provided little evidence for superiority of one drug over another. Specifically, mortality reduction versus placebo for each of these drugs was identical (34% to 35%). Yet questions persist about potential superiority of carvedilol, in part because it appears to be superior in its effects on certain parameters, such as change in EF, and certain hemodynamic responses at peak exercise. ... 

When the primary prevention trials started using LVEF as essentially the sole criterion for ICD implantation (i.e., not requiring inducibility of VT/VF at EPS), the absolute reduction in mortality decreased with a corresponding increase in the number needed to treat to save one life. For instance, in MUSTT the absolute reduction in mortality was 31% and the number needed to treat was three at five years, and in MADIT the absolute reduction in mortality was 19% with a number needed to treat of four at two years. However, in MADIT-II and SCD-HeFT the absolute mortality reduction was 6% and 7% respectively, with a number... 

In patients with nonischemic cardiomyopathy, NSVT does not seem to be predictive of SCD. In DEFINITE (28), which used NSVT as part of the selection process, the absolute mortality reduction was 6.2%. In SCD-HeFT (29) where NSVT was not an inclusion criterion, there was a similar reduction in mortality of 7.2%, implying that NSVT does not provide additional risk stratification beyond LVEF and HF class. In the... 

In patients with nonischemic cardiomyopathy, the DEFINITE trial did not show a relationship between QRS duration and all-cause mortality (28). In the Marburg Cardiomyopathy Study, neither left nor right bundle branch block predicted SCD (63). While SCD-HeFT reported a greater benefit of ICD therapy in mortality reduction in patients with a QRS >120 msec, the data include patients with both ischemic and... 

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