Comparison of clinical results of pharmaceutical and surgical therapy in patients with severe chronic heart failure

The aim of the presented paper is a meta-analysis of clinical studies on the comparative effectiveness of pharmaceutical therapy and surgical treatment such as cardiac resynchronization therapy (CRT), cardiac resynchronization therapy with cardioversion-defibrillation (CRT-D), circulatory support system and heart transplantation in patients with severe chronic heart failure (CHF). Material and Methods. Results of 41 clinical studies (29799 patients with severe CHF) were included in a meta-analysis. Data search was conducted in the following databases: Medline, Medscape, Pubmed, and websites dedicated to clinical research (National Institutes of Health, Clinical Center, ClinicalStudyResults.org, ClinicalTrials.gov). Results. As compared with pharmaceutical therapy, surgical treatment of severe CHF is better to reduce fatal risk, incidence of decompensation of CHF, frequency of cardiac arrhythmias, the need to perform or re-perform heart transplantation. It is also shown that CRT better reduced the mortality from progression of heart failure than heart transplantation. Both pharmaceutical therapy and surgical treatment improved functional class of CHF and quality of patients'' life, but does not affect the left ventricular ejection fraction. Conclusion. It was found out that there was a number of significant advantages of surgical treatment of severe CHF, compared with pharmaceutical therapy. However, it is still a number of unresolved issues (particularly in relation to heart transplantation) on the effectiveness comparing pharmaceutical and surgical therapies of severe CHF