Showing papers by "John P. Boehmer published in 2009"
TL;DR: ICD therapy reduced cardiac mortality and sudden death presumed to be ventricular tachyarrhythmic in SCD-HeFT and had no effect on heart failure mortality.
Abstract: Background— The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) demonstrated that implantable cardioverter-defibrillator (ICD) therapy reduces all-cause mortality in patients with New York Heart Association class II/III heart failure and a left ventricular ejection fraction ≤35% on optimal medical therapy. Whether ICD therapy reduced sudden death caused by ventricular tachyarrhythmias without affecting heart failure deaths in this population is unknown. Methods and Results— SCD-HeFT randomized 2521 subjects to placebo, amiodarone, or shock-only, single-lead ICD therapy. Over a median follow-up of 45.5 months, a total of 666 deaths occurred, which were reviewed by an Events Committee and initially categorized as cardiac or noncardiac. Cardiac deaths were further adjudicated as resulting from sudden death presumed to be ventricular tachyarrhythmic, bradyarrhythmia, heart failure, or other cardiac causes. ICD therapy significantly reduced cardiac mortality compared with placebo (adjusted hazard ratio,...
221 citations
Veterans Health Administration1, Boston Scientific Corporation2, University of North Carolina at Chapel Hill3, Sharp Memorial Hospital4, Detroit Medical Center5, Pennsylvania State University6, University of Colorado Denver7, Duke University8, Mount Sinai St. Luke's and Mount Sinai Roosevelt9, Thomas Jefferson University10, University of Wisconsin-Madison11
TL;DR: Use of CRT with or without a defibrillator in advanced heart failure patients was associated with marked reductions in all-cause, cardiac, and heart failure hospitalization rates in an analysis that accounted for the competing risk of mortality and unequal follow-up time.
Abstract: Background— In the Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure (COMPANION) trial, 1520 patients with advanced heart failure were assigned in a 1:2:2 ratio to optimal pharmacological therapy or optimal pharmacological therapy plus cardiac resynchronization therapy (CRT-P) or CRT with defibrillator (CRT-D). Use of CRT-P and CRT-D was associated with a significant reduction in combined risk of death or all-cause hospitalizations. Because mortality also was significantly reduced (optimal pharmacological therapy versus CRT-D only), an assessment of the true reduction in hospitalization rates must consider the competing risk of death and varying follow-up times. Methods and Results— To overcome the challenges of comparing treatment groups, we used a nonparametric test of right-censored recurrent events that accounts for multiple hospital admissions, differential follow-up time between treatment groups, and death as a competing risk. An end-point committee adjudicated and classified...
156 citations
TL;DR: Comparing responses were noted during systemic hypoxia and hyperoxia where mechanisms independent of autonomic influences appear to dominate the vascular end-organ effects, and physiological stress known to be associated with sympathetic activation can produce coronary vasoconstriction in humans.
Abstract: Animal reports suggest that reflex activation of cardiac sympathetic nerves can evoke coronary vasoconstriction. Conversely, physiological stress may induce coronary vasodilation to meet an increas...
67 citations
TL;DR: In a multivariable analysis controlling for significant baseline characteristics and use of CRT-P/CRT-D, statin use was associated with a 23% relative risk reduction in mortality and improved survival in patients with advanced chronic HF receiving CRT.
Abstract: It is unknown whether statin use improves survival in patients with advanced chronic heart failure (HF) receiving cardiac resynchronization therapy (CRT). The authors retrospectively assessed the effect of statin use on survival in patients with advanced chronic HF receiving CRT alone (CRT-P) or CRT with implantable cardioverter-defibrillator therapy (CRT-D) in 1520 patients with advanced chronic HF from the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial database. Six hundred three patients (40%) were taking statins at baseline. All-cause mortality was 18% in the statin group and 22% in the no statin group (hazard ratio [HR] 0.85; confidence interval (CI), 0.67-1.07; P=.15). In a multivariable analysis controlling for significant baseline characteristics and use of CRT-P/CRT-D, statin use was associated with a 23% relative risk reduction in mortality (HR, 0.77; CI, 0.61-0.97; P=.03). Statin use is associated with improved survival in patients with advanced chronic HF receiving CRT. No survival benefit was seen in patients receiving statins and optimal pharmacologic therapy without CRT.
10 citations
TL;DR: Evidence from a randomized controlled study, even for the authors' new, “obviously better” therapies, reduces potential biases—biases that may be stronger than the actual benefit of their new treatment.
Abstract: on quality of life and medical outcomes in a double-blind placebo surgery trial. Arch. Gen. Psychiatry 61, 412–420 (2004). 4. Benedetti, F., Pollo, A., Lopiano, L., Lanotte, M., Vighetti, S. & Rainero, I. Conscious expectation and unconscious conditioning in analgesic, motor, and hormonal placebo/nocebo responses. J. Neurosci. 23, 4315–4323 (2003). 5. Kaptchuk, T.J. et al. Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ 336, 999– 1003 (2008). 6. Travis, K. Bernard Fisher reflects on a halfcentury’s worth of breast cancer research. J. Natl. Cancer Inst. 97, 1636–1637 (2005). 7. Ruskin, J.N. The cardiac arrhythmia suppression trial (CAST). N. Engl. J. Med. 321, 386–388 (1989). 8. Freed, C.R. et al. Transplantation of embryonic dopamine neurons for severe Parkinson’s disease. N. Engl. J. Med. 344, 710–719 (2001). 9. Moseley, J.B. et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N. Engl. J. Med. 347, 81–88 (2002). 10. de la Fuente-Fernández, R., Ruth, T.J., Sossi, V., Schulzer, M., Calne, D.B. & Stoessl, A.J. Expectation and dopamine release: mechanism of the placebo effect in Parkinson’s disease. Science 293, 1164–1166 (2001). evidence from a randomized controlled study, even for our new, “obviously better” therapies. Blinding, even when imperfect, reduces potential biases—biases that may be stronger than the actual benefit of our new treatment.
4 citations
1 citations
01 Jan 2009