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Amiodarone or an Implantable Cardioverter-Defibrillator for Congestive Heart Failure

Amiodarone or an Implantable Cardioverter-Defibrillator for Congestive Heart Failure,Gust H. Bardy,Kerry L. Lee,Daniel B. Mark,Jeanne E. Poole,Douglas

Amiodarone or an Implantable Cardioverter-Defibrillator for Congestive Heart Failure   (Citations: 382)
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Gust H. Bardy, Kerry L. Lee, Daniel B. Mark, Jeanne E. Poole, Douglas L. Packer, Robin Boineau, Michael Domanski, Charles Troutman, Jill Anderson, Steven E. McNulty, Nancy Clapp-Channing, Linda D. Davidson-Rayhttp://academic.research.microsoft.com/io.ashx?type=5&id=13072737&selfId1=0&selfId2=0&maxNumber=12&query=
background Sudden death from cardiac causes remains a leading cause of death among patients with congestive heart failure (CHF). Treatment with amiodarone or an implantable cardio- verter-defibrillator (ICD) has been proposed to improve the prognosis in such patients. methods We randomly assigned 2521 patients with New York Heart Association (NYHA) class II or III CHF and a left ventricular ejection fraction (LVEF) of 35 percent or less to conven- tional therapy for CHF plus placebo (847 patients), conventional therapy plus amioda- rone (845 patients), or conventional therapy plus a conservatively programmed, shock- only, single-lead ICD (829 patients). Placebo and amiodarone were administered in a double-blind fashion. The primary end point was death from any cause. results The median LVEF in patients was 25 percent; 70 percent were in NYHA class II, and 30 percent were in class III CHF. The cause of CHF was ischemic in 52 percent and nonis- chemic in 48 percent. The median follow-up was 45.5 months. There were 244 deaths (29 percent) in the placebo group, 240 (28 percent) in the amiodarone group, and 182 (22 percent) in the ICD group. As compared with placebo, amiodarone was associated with a similar risk of death (hazard ratio, 1.06; 97.5 percent confidence interval, 0.86 to 1.30; P=0.53) and ICD therapy was associated with a decreased risk of death of 23 per- cent (0.77; 97.5 percent confidence interval, 0.62 to 0.96; P=0.007) and an absolute decrease in mortality of 7.2 percentage points after five years in the overall population. Results did not vary according to either ischemic or nonischemic causes of CHF, but they did vary according to the NYHA class. conclusions In patients with NYHA class II or III CHF and LVEF of 35 percent or less, amiodarone has no favorable effect on survival, whereas single-lead, shock-only ICD therapy reduces overall mortality by 23 percent.
Published in 2010.
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