Patients with symptomatic heart failure in the more recent CHART-2 cohort had a significantly lower 3-year incidence of all-cause death compared to the older CHART-1 cohort (15% vs 24%, adjHR 0.73).
Cohort (n=4,682)
Yes
Does contemporary heart failure management improve prognosis in symptomatic heart failure patients compared to historical management?
Hazard Ratio: 0.73
Absolute Event Rate: 15% vs 24%
Absolute Risk Reduction: 9%
p-value: p=<0.001
BACKGROUND: Temporal trends in clinical characteristics, management and prognosis of patients with symptomatic heart failure (HF) remain to be elucidated in Japan. METHODS AND RESULTS: From the Chronic Heart Failure Analysis and Registry in the Tohoku District-1 (CHART-1; 2000-2005, n=1,278) and CHART-2 (2006-present, n=10,219) Studies, we enrolled 1,006 and 3,676 consecutive symptomatic stage C/D HF patients, respectively. As compared with the patients in the CHART-1 Study, those in the CHART-2 Study had similar age and sex prevalence, and were characterized by lower brain natriuretic peptide, higher prevalence of preserved left ventricular ejection fraction (LVEF) and higher prevalence of hypertension, diabetes mellitus and ischemic heart disease (IHD), particularly IHD with LVEF ≥50%. From CHART-1 to CHART-2, use of renin-angiotensin system inhibitors, β-blockers and aldosterone antagonists was significantly increased, while that of loop diuretics and digitalis was decreased. Three-year incidences of all-cause death (24 vs. 15%; adjusted hazard ratio adjHR, 0.73; P<0.001), cardiovascular death (17 vs. 7%; adjHR, 0.38; P<0.001) and hospitalization for HF (30 vs. 17%; adjHR, 0.51; P<0.001) were all significantly decreased from CHART-1 to CHART-2. In the CHART-2 Study, use of β-blockers was associated with improved prognosis in patients with LVEF <50%, while that of statins was associated with improved prognosis in those with LVEF ≥50%. CONCLUSIONS: Along with implementation of evidence-based medications, the prognosis of HF patients has been improved in Japan. ( TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT00418041)
Ushigome et al. (2015) conducted a cohort in Symptomatic heart failure (n=4,682). More recent treatment era (CHART-2, 2006-present) vs. Older treatment era (CHART-1, 2000-2005) was evaluated on 3-year incidence of all-cause death (adjHR 0.73, p=<0.001). Patients with symptomatic heart failure in the more recent CHART-2 cohort had a significantly lower 3-year incidence of all-cause death compared to the older CHART-1 cohort (15% vs 24%, adjHR 0.73).