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American Journal of Critical Care. 2008;17: 443-452
Copyright © 2008 by the American Association of Critical-Care Nurses.
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CE Article

Reducing Mortality With Device Therapy in Heart Failure Patients Without Ventricular Arrhythmias

By Deborah W. Chapa, PhD, ARNP-BC, Hyeon-Joo Lee, RN, MS, ANP-C, Chi-Wen Kao, RN, PhD, Erika Friedmann, PhD, Sue A. Thomas, RN, PhD, Jill Anderson, RN, BSN and Gust H. Bardy, MD. Deborah W. Chapa is an assistant professor at Florida Gulf Coast University, Fort Myers, Florida. Hyeon-Joo Lee is a doctoral student, Erika Friedmann is a professor, and Sue A. Thomas is assistant dean of the PhD program and a professor at the University of Maryland School of Nursing, Baltimore, Maryland. Chi-Wen Kao is an assistant professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan. Jill Anderson is director of clinical affairs and Gust H. Bardy is president of the Seattle Institute for Cardiovascular Research, Seattle, Washington.

Corresponding author: Sue A. Thomas, RN, PhD, University of Maryland School of Nursing, 655 W. Lombard St, Baltimore, MD 21201 (e-mail: Thomas{at}son.umaryland.edu).

Use of device therapy to prevent sudden cardiac death in patients with heart failure is expanding on the basis of evidence from recent clinical trials. Three multicenter prospective clinical trials—Sudden Cardiac Death in Heart Failure (SCD-HeFT); Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION); and Cardiac Resynchronization-Heart Failure (CARE-HF)—were conducted to determine the effectiveness of devices in reducing mortality in patients with heart failure who did not have a history of ventricular arrhythmias. The 3 trials varied in the devices used, the population of patients included, and the study designs. In SCD-HeFT, implantable cardioverter defibrillators were more effective than pharmacological therapy in preventing mortality among patients with mild to moderate heart failure. In COMPANION, cardiac resynchronization therapy alone and cardiac resynchronization therapy plus an implantable cardioverter defibrillator were more effective than optimal drug treatment in reducing morbidity and all-cause mortality in patients with moderate to severe heart failure. In CARE-HF, cardiac resynchronization therapy alone was more effective than optimal drug treatment in reducing all-cause mortality in patients with moderate to severe heart failure. No direct comparison of the devices used has been done. These 3 clinical trials provide clear evidence that device therapy is beneficial for some patients with heart failure, even patients who do not have a history of ventricular arrhythmia.

Notice to CE enrollees:
A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe the pathophysiology of heart failure leading to sudden cardiac death.
  2. Recognize different devices used to treat patients with heart failure.
  3. Understand how pacemaker/ICD devices can decrease the overall mortality of patients with heart failure.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


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[Full Text] [PDF]


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Copyright © 2008 by the American Association of Critical-Care Nurses.