Comparison of impact of medical therapy and surgical treatment on overall mortality in patients with severe chronic heart failure: a meta-analysis

Aim ― Meta-analysis of clinical trials comparing the efficacy of medical therapy (MT) and surgical treatment, including cardiac resynchronization therapy with and without cardioversion-defibrillation (CRT and CRT-D), circulatory support system (CSS) and heart transplantation (HT), in terms of decreasing overall mortality in patients with severe chronic heart failure (CHF). Material and Methods ― Meta-analysis included 39 clinical trials with a total number of 30,257 patients. Search was performed in MEDLINE, Medscape, Pubmed databases and on web resources, dedicated to clinical trials (National Institutes of Health, Clinical Center, ClinicalStudyResults.org, ClinicalTrials.gov). Results ― There was no significant overall mortality reduction in patients receiving MT when compared to control group: OR=0.97 (95% CI: 0.85-1.10), p=0.211. Treatment with CRT and CRT-D, as well as CSS implantation and HT reduced overall mortality: OR=0.67 (95% CI: 0.57–0.79), p < 0.001 for CRT/CRT-D and OR=0.46 (95% CI: 0.24–0.86), p = 0.018 for CSS/HT. Conclusion ― Superiority of surgical treatment over traditional MT in terms of overall mortality was observed in patients with severe CHF