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VIEWPOINT AND COMMENTARY

Why Should We Care About CARE-HF?

Kenneth A. Ellenbogen, MD, FACC^_*,_*, Mark A. Wood, MD, FACC^_* and Helmut U. Klein, MD, FACC

^_* Department of Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
Division of Cardiology, University Hospital, Magdeburg, Germany

Manuscript received March 29, 2005; revised manuscript received July 12, 2005, accepted July 18, 2005.

^_* Reprint requests and correspondence: Dr. Kenneth A. Ellenbogen, Medical College of Virginia, P.O. Box 980053, Richmond, Virginia 23298-0053. (Email: kaellenb{at}vcu.edu).

Previous trials of cardiac resynchronization therapy (CRT) have suggested that this therapy can significantly improve functional class and exercise capacity during short-term follow-up. The impact of this therapy on morbidity and mortality has only recently been reported. The Cardiac Resynchronization-Heart Failure (CARE-HF) study has definitively shown that CRT significantly reduces mortality (36%, p < 0.002) in patients with NYHA functional class III and IV heart failure and ventricular dyssynchrony. This study also shows that CRT reverses ventricular remodeling and improves myocardial performance progressively for at least 18 months. In heart failure patients, the CARE-HF and Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) (the earlier major morbidity/mortality trial) studies together show the unequivocal benefit for CRT therapy and CRT therapy with back-up defibrillation to significantly reduce mortality and hospitalization compared with optimal medical therapy. Both studies suggest the benefit of adding the implantable cardiac defibrillator to CRT devices, as over one-third of deaths in the CRT-pacemaker arm of both the COMPANION and CARE-HF studies were sudden.

Abbreviations and Acronyms   CARE-HF = Cardiac Resynchronization-Heart Failure study   COMPANION = Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure study   CRT = cardiac resynchronization therapy   CRT-D = cardiac resynchronization therapy pacemaker plus back-up defibrillation (implantable cardiac defibrillator)   CRT-P = cardiac resynchronization therapy pacemaker   ICD = implantable cardiac defibrillator   MERIT-HF = Metoprolol Randomized Intervention Trial in Congestive Heart Failure   NYHA = New York Heart Association   OPT = optimal pharmacologic therapy

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