S. Stawicki

535 Effect of the optimal neurohormonal blockade on survival in high-risk patients groups with chronic heart failure

Background: It has been proven that modulation of the neurohormonaJ activation with beta-blockers (LBA), ACE-inhibitors (ACE-I) and spironolactone improve survival in patients (pts) with chronic heart failure (CHF). However in most of the trials pts from the high-risk groups were excluded, so there is still little evidence whether such therapy is beneficial for this subpopulations. Aim: The aim of this study was to estimate the effect of the optimal neurohormonaJ blockade (ONB) on one-year mortality among high-risk patients groups with CHE Methods: 501 consecutive pts with NYHA II IV class referred to our Department due to CHF were enrolled (mean age 694-11,316 male). We defined ONB as use of LBA and ACE-I in pts with NYHA II or LBA, ACE-I and spironolactone in pts with NYHA III-IV. Subgroup analyses were conducted for pts who were either elderly (>65 years)-gr.A (319 pts), had type 2 diabetes mellitus-gr.B (129 pts), low hemoglobine level ( 1.4 mg/dl)-gr.F (142 pts). Results: In groups A-F, respectively 45%, 47%, 39%, 36%, 44% and 31% of pts received ONB. One-year mortality in pts receiving optimal therapy was significantly lower in compare to pts with non-optimaJ therapy: gr.A: 13% vs. 45% (p<0.001), gr.B: 15% vs. 40% (p<0.005), gr.C: 13% vs. 53% (p<0.001), gr.D: 19% vs. 60% (p<0.001), gr.E: 21% vs. 44% (p<0.01), gr.F: 30% vs. 50% (p<0.05). Cox multivariate analysis showed that ONB independently reduced one-year mortality in each group (Table 1).