Beta-blockers and amiodarone for the primary prevention of sudden cardiac death

Frankenberger, Olivier; Steinber, Jonathan S.

doi:10.1007/s11886-999-0050-8

Cited by 3 publications

(2 citation statements)

References 52 publications

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“…However, in a post‐hoc analysis it was found that lower serum digoxin concentrations are associated with improved survival [31]. A clinically relevant reduction of the risk of sudden cardiac death could be demonstrated for β‐blocking agents alone [32 34].…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of Crataegus extract WS® 1442 in patients with heart failure: The SPICE trial

Holubarsch

Colucci

Meinertz

et al. 2008

European J of Heart Fail

102

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Background: Crataegus preparations have been used for centuries especially in Europe. To date, no proper data on their efficacy and safety as an add‐on‐treatment are available. Therefore a large morbidity/mortality trial was performed. Aim: To investigate the efficacy and safety of an add‐on treatment with Crataegus extract WS® 1442 in patients with congestive heart failure. Methods: In this randomised, double‐blind, placebo‐controlled multicenter study, adults with NYHA class II or III CHF and reduced left ventricular ejection fraction (LVEF≤35%) were included and received 900 mg/day WS® 1442 or placebo for 24 months. Primary endpoint was time until first cardiac event. Results: 2681 patients (WS® 1442: 1338; placebo: 1343) were randomised. Average time to first cardiac event was 620 days for WS® 1442 and 606 days for placebo (event rates: 27.9% and 28.9%, hazard ratio (HR): 0.95, 95% CI [0.82;1.10]; p=0.476). The trend for cardiac mortality reduction with WS® 1442 (9.7% at month 24; HR: 0.89 [0.73;1.09]) was not statistically significant (p=0.269). In the subgroup with LVEF ≥ 25%, WS® 1442 reduced sudden cardiac death by 39.7% (HR 0.59 [0.37;0.94] at month 24; p=0.025). Adverse events were comparable in both groups. Conclusions: In this study, WS® 1442 had no significant effect on the primary endpoint. WS® 1442 was safe to use in patients receiving optimal medication for heart failure. In addition, the data may indicate that WS® 1442 can potentially reduce the incidence of sudden cardiac death, at least in patients with less compromised left ventricular function.

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Section: Discussionmentioning

confidence: 99%

The efficacy and safety of Crataegus extract WS® 1442 in patients with heart failure: The SPICE trial

Holubarsch

Colucci

Meinertz

et al. 2008

European J of Heart Fail

102

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“…37,41,63 As the neurohormonal hypothesis emerged, so too did a new understanding of the potential role of ␤-blockers in heart failure. Although acute treatment with ␤-blockers decreases blood pressure and cardiac index, long-term administration of ␤-blockers is associated with significant increases in ejection fraction [64][65][66][67][68][69][70][71][72][73][74][75][76][77] and cardiac index and a decrease in left ventricular (LV) end diastolic pressure. 61,[77][78][79][80][81][82][83][84][85][86][87] ␤-Blockers reverse the deleterious changes associated with LV remodeling and decrease myocardial mass and LV volume, leading to improved hemodynamics.…”

Section: Laboratory Sciencementioning

confidence: 99%

β-Blocker Therapy in Heart Failure

Foody¹,

Farrell²,

Krumholz³

2002

JAMA

286

151

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Context Care of patients with heart failure has been revolutionized throughout the past decade. A paradigm shift in the strategy for treating heart failure caused by systolic dysfunction is in progress. Despite the initial perception about ␤-blockers' safety, they are now the most extensively studied class of agents in the treatment of heart failure and have emerged as an important intervention to improve the clinical outcomes of heart failure patients.Objective To provide scientific rationale for the use of ␤-blockers for patients with heart failure.Data Sources All English-language articles of large, randomized controlled clinical trials assessing the mortality benefits of ␤-blockers in patients with heart failure were identified to provide the scientific rationale for the use of ␤-blockers in heart failure. Basic science studies were reviewed to provide an overview of the potential physiologic role of ␤-blockers in heart failure. Finally, clinical guidelines for the treatment of patients with heart failure were assessed to determine current recommendations for the use of these agents. Study Selection and Data ExtractionRandomized controlled clinical trials of ␤-blockers that included more than 300 subjects and assessed mortality as a primary end point. Data SynthesisOf the 4 ␤-blockers tested in large randomized controlled clinical trials of patients with heart failure, 3 are available in the United States, bisoprolol, carvedilol, and metoprolol; 2 of these, carvedilol and metoprolol, have Food and Drug Administration indications for the treatment of heart failure. Compared with placebo treatment, ␤-blocker use is associated with a consistent 30% reduction in mortality and a 40% reduction in hospitalizations in patients with class II and III heart failure.Conclusions Tested in more than 10 000 patients, ␤-blockers reduce morbidity and mortality in class II through IV heart failure. Along with angiotensin-converting enzyme inhibitors, digoxin, and diuretics, ␤-blockers have strengthened the armamentarium to improve clinical outcomes of heart failure patients. The science supporting ␤-blockers must be translated into practice safely and rationally if the agents are to achieve their full potential.

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Managing dystrophinopathic cardiomyopathy

Politano

Nigro²

2016

Expert Opinion on Orphan Drugs

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Beta-blockers and amiodarone for the primary prevention of sudden cardiac death

Cited by 3 publications

References 52 publications

The efficacy and safety of Crataegus extract WS® 1442 in patients with heart failure: The SPICE trial

The efficacy and safety of Crataegus extract WS® 1442 in patients with heart failure: The SPICE trial

β-Blocker Therapy in Heart Failure

Managing dystrophinopathic cardiomyopathy

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