Optimal medical therapy is superior to transplantation for the treatment of class I, II, and III heart failure : A decision analytic approach
The survival benefit of heart transplantation (HT) compared with optimal medical therapy (OMT) has never been tested. 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 l...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2006-07, Vol.114 (1), p.I62-I66 |
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| creator | FREUDENBERGER, R. S KIM, J TAWFIK, I SONNENBERG, F. A |
| description | The survival benefit of heart transplantation (HT) compared with optimal medical therapy (OMT) has never been tested.
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.
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. |
| doi_str_mv | 10.1161/CIRCULATIONAHA.105.001412 |
| format | Article |
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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.
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.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.105.001412</identifier><identifier>PMID: 16820647</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood. Blood coagulation. Reticuloendothelial system ; Cardiology. Vascular system ; Cohort Studies ; Comorbidity ; Computer Simulation ; Death, Sudden - epidemiology ; Death, Sudden, Cardiac - epidemiology ; Decision Support Techniques ; Decision Trees ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Heart Failure - classification ; Heart Failure - drug therapy ; Heart Failure - mortality ; Heart Failure - surgery ; Heart Transplantation ; Humans ; Life Expectancy ; Markov Chains ; Medical sciences ; Miscellaneous ; Models, Theoretical ; Neoplasms - mortality ; Pharmacology. Drug treatments ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Randomized Controlled Trials as Topic - statistics & numerical data ; Renal Insufficiency - mortality ; Risk ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2006-07, Vol.114 (1), p.I62-I66</ispartof><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c337t-ad2f7a5337434adca358d74e4743e65fedfe3dd186051276208c7befedfd33bb3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,778,782,787,788,3676,23913,23914,25123,27907,27908</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17948313$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16820647$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FREUDENBERGER, R. S</creatorcontrib><creatorcontrib>KIM, J</creatorcontrib><creatorcontrib>TAWFIK, I</creatorcontrib><creatorcontrib>SONNENBERG, F. A</creatorcontrib><title>Optimal medical therapy is superior to transplantation for the treatment of class I, II, and III heart failure : A decision analytic approach</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>The survival benefit of heart transplantation (HT) compared with optimal medical therapy (OMT) has never been tested.
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.
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.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Cardiology. Vascular system</subject><subject>Cohort Studies</subject><subject>Comorbidity</subject><subject>Computer Simulation</subject><subject>Death, Sudden - epidemiology</subject><subject>Death, Sudden, Cardiac - epidemiology</subject><subject>Decision Support Techniques</subject><subject>Decision Trees</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Heart Failure - classification</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - surgery</subject><subject>Heart Transplantation</subject><subject>Humans</subject><subject>Life Expectancy</subject><subject>Markov Chains</subject><subject>Medical sciences</subject><subject>Miscellaneous</subject><subject>Models, Theoretical</subject><subject>Neoplasms - mortality</subject><subject>Pharmacology. Drug treatments</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Randomized Controlled Trials as Topic - statistics & numerical data</subject><subject>Renal Insufficiency - mortality</subject><subject>Risk</subject><subject>Severity of Illness Index</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUU2P0zAQtRCILQt_AZkDnEix46-UW1QBG6miEto9R1N7rBqlSbCdQ38E_xlXrbTiYD3P05sZzXuEfOBszbnmX7bdr-3Trn3s9j_bh3bNmVozxiWvX5AVV7WspBKbl2TFGNtURtT1HXmT0u9SamHUa3LHdVMzLc2K_N3POZxgoCd0wRbMR4wwn2lINC0zxjBFmieaI4xpHmDMkMM0Un-hj1h4hHzCMdPJUztASrT7TLvyYHQFO3pEiJl6CMMSkX6lLXVoQ7oMgRGGcw6WwjzHCezxLXnlYUj47ob35On7t8ftQ7Xb_-i27a6yQphcgau9AVX-UkhwFoRqnJEoS41aeXQehXO80Uzx2uiaNdYc8MI7IQ4HcU8-XeeWtX8WTLk_hWRxKPfhtKReN5oLbkQRbq5CG6eUIvp-jsWueO456y9Z9P9nUWjVX7Move9vS5ZDcfe582Z-EXy8CSAV632xuBjzrDMb2QguxD8G0JVl</recordid><startdate>20060704</startdate><enddate>20060704</enddate><creator>FREUDENBERGER, R. S</creator><creator>KIM, J</creator><creator>TAWFIK, I</creator><creator>SONNENBERG, F. A</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20060704</creationdate><title>Optimal medical therapy is superior to transplantation for the treatment of class I, II, and III heart failure : A decision analytic approach</title><author>FREUDENBERGER, R. S ; KIM, J ; TAWFIK, I ; SONNENBERG, F. A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-ad2f7a5337434adca358d74e4743e65fedfe3dd186051276208c7befedfd33bb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Cardiology. Vascular system</topic><topic>Cohort Studies</topic><topic>Comorbidity</topic><topic>Computer Simulation</topic><topic>Death, Sudden - epidemiology</topic><topic>Death, Sudden, Cardiac - epidemiology</topic><topic>Decision Support Techniques</topic><topic>Decision Trees</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Heart Failure - classification</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - surgery</topic><topic>Heart Transplantation</topic><topic>Humans</topic><topic>Life Expectancy</topic><topic>Markov Chains</topic><topic>Medical sciences</topic><topic>Miscellaneous</topic><topic>Models, Theoretical</topic><topic>Neoplasms - mortality</topic><topic>Pharmacology. Drug treatments</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Randomized Controlled Trials as Topic - statistics & numerical data</topic><topic>Renal Insufficiency - mortality</topic><topic>Risk</topic><topic>Severity of Illness Index</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FREUDENBERGER, R. S</creatorcontrib><creatorcontrib>KIM, J</creatorcontrib><creatorcontrib>TAWFIK, I</creatorcontrib><creatorcontrib>SONNENBERG, F. A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FREUDENBERGER, R. S</au><au>KIM, J</au><au>TAWFIK, I</au><au>SONNENBERG, F. A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimal medical therapy is superior to transplantation for the treatment of class I, II, and III heart failure : A decision analytic approach</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2006-07-04</date><risdate>2006</risdate><volume>114</volume><issue>1</issue><spage>I62</spage><epage>I66</epage><pages>I62-I66</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>The survival benefit of heart transplantation (HT) compared with optimal medical therapy (OMT) has never been tested.
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.
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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>16820647</pmid><doi>10.1161/CIRCULATIONAHA.105.001412</doi></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2006-07, Vol.114 (1), p.I62-I66 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Adrenergic beta-Antagonists - therapeutic use Biological and medical sciences Blood and lymphatic vessels Blood. Blood coagulation. Reticuloendothelial system Cardiology. Vascular system Cohort Studies Comorbidity Computer Simulation Death, Sudden - epidemiology Death, Sudden, Cardiac - epidemiology Decision Support Techniques Decision Trees Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Heart Failure - classification Heart Failure - drug therapy Heart Failure - mortality Heart Failure - surgery Heart Transplantation Humans Life Expectancy Markov Chains Medical sciences Miscellaneous Models, Theoretical Neoplasms - mortality Pharmacology. Drug treatments Public health. Hygiene Public health. Hygiene-occupational medicine Randomized Controlled Trials as Topic - statistics & numerical data Renal Insufficiency - mortality Risk Severity of Illness Index Survival Analysis Treatment Outcome |
| title | Optimal medical therapy is superior to transplantation for the treatment of class I, II, and III heart failure : A decision analytic approach |
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