PMID- 16820647
OWN - NLM
STAT- MEDLINE
DCOM- 20060818
LR  - 20101118
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 114
IP  - 1 Suppl
DP  - 2006 Jul 4
TI  - Optimal medical therapy is superior to transplantation for the treatment of class 
      I, II, and III heart failure: a decision analytic approach.
PG  - I62-6
AB  - BACKGROUND: The survival benefit of heart transplantation (HT) compared with 
      optimal medical therapy (OMT) has never been tested. METHODS AND RESULTS: We 
      created a decision analytic model that simulates a randomized clinical trial of 
      OMT versus HT for each New York Heart Association (NYHA) class. The simulation 
      calculates average life expectancy. The following assumptions were made for OMT 
      annual mortality: class I no excess mortality from HF; class II and III based on 
      MERIT-HF are 5.3% and 8.1%. Class IV is 12.8%, based on COPERNICUS. HT mortality 
      rates were based on survival curves for HT 1982 to 2001. For classes I, II, and 
      III, OMT demonstrated a life expectancy gain of 113 months (232+/-2.2 versus 
      119+/-2.1), 38 months (152+/-2.1 versus 114+/-2.1), and 6 months (117+/-1.8 
      versus 111+/-2.2), respectively, over HT. Class IV favored HT with a life 
      expectancy gain of 26 months (107+/-2.1 versus 81+/-1.4) over OMT. Sensitivity 
      analysis revealed if improvement in OMT decreased mortality by 38% for class IV 
      patients, OMT and HT would have equivalent life expectancies. If improvement in 
      HT resulted in a 7% increase in post-HT survival, OMT and HT would be equivalent 
      for class III patients. If improvement in HT resulted in a 30% increase in 
      post-HT survival, OMT and HT would be equivalent for class II patients. 
      CONCLUSIONS: Our model predicts that currently, OMT is superior to HT for classes 
      I, II, and III, but HT is superior for class IV. However, future advances in OMT 
      or HT may change the relative benefits of these treatment modalities.
FAU - Freudenberger, R S
AU  - Freudenberger RS
AD  - University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical 
      School, New Brunswick, NJ, USA. freuders@umdnj.edu
FAU - Kim, J
AU  - Kim J
FAU - Tawfik, I
AU  - Tawfik I
FAU - Sonnenberg, F A
AU  - Sonnenberg FA
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
RN  - 0 (Adrenergic beta-Antagonists)
SB  - IM
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Cohort Studies
MH  - Comorbidity
MH  - *Computer Simulation
MH  - Death, Sudden/epidemiology
MH  - Death, Sudden, Cardiac/epidemiology
MH  - *Decision Support Techniques
MH  - Decision Trees
MH  - Heart Failure/classification/*drug therapy/mortality/*surgery
MH  - *Heart Transplantation
MH  - Humans
MH  - Life Expectancy
MH  - Markov Chains
MH  - *Models, Theoretical
MH  - Neoplasms/mortality
MH  - Randomized Controlled Trials as Topic/*statistics & numerical data
MH  - Renal Insufficiency/mortality
MH  - Risk
MH  - Severity of Illness Index
MH  - Survival Analysis
MH  - Treatment Outcome
EDAT- 2006/07/06 09:00
MHDA- 2006/08/19 09:00
CRDT- 2006/07/06 09:00
PHST- 2006/07/06 09:00 [pubmed]
PHST- 2006/08/19 09:00 [medline]
PHST- 2006/07/06 09:00 [entrez]
AID - 114/1_suppl/I-62 [pii]
AID - 10.1161/CIRCULATIONAHA.105.001412 [doi]
PST - ppublish
SO  - Circulation. 2006 Jul 4;114(1 Suppl):I62-6. doi: 
      10.1161/CIRCULATIONAHA.105.001412.