To determine the effect of recent advances in medical management on the survival of patients with dilated cardiomyopathy (DCM), 103 patients with DCM were studied. The subjects were divided into 3 groups based upon the time of initial medical treatment at our institute: Group I, between 1976 and 1981, 20 patients; Group II, between 1982 and 1985, 27 patients; and Group III, between 1986 and 1991, 56 patients. The clinical, Holter electrocardiographic and echocardiographic findings, the pharmacologic treatments used, and the clinical outcomes for the 3 groups of patients were compared. During the follow-up period, which averaged 27 months, 31 deaths related to cardiac disease occurred. The 4 year survival rate was 76% in Group III, 49% in Group II and 35% in Group I; the difference in survival rate between Groups I and III was significant (p<0.01). At the initial evaluation, no differences were found among the 3 groups in the incidences of advanced heart failure (NYHA functional class III or IV), atrial fibrillation or complex ventricular arrhythmias. Neither diastolic blood pressure nor heart rate differed among the 3 groups, but Group III patients were older and had significantly higher systolic blood pressures than Group I patients (p<0.05, for both comparisons). There were no differences among the 3 groups in % fractional shortening, left ventricular end-systolic wall stress or left ventricular wall thickness, but left ventricular dimensions were significantly smaller in Group III than in Group I (p<0.05). Digitalis and/or diuretic agents were administered to all of the patients of Groups I and II and to most of the patients of Group III. There were no differences among the 3 groups in the number of patients who received antiarrhythmics or anticoagulants, but vasodilators and β-blockers were used more frequently in Group III than in Groups I and II (p<0.01 for each comparison). In conclusion, the prognosis of DCM has improved, and various factors, including recent advances in pharmacologic treatments, have contributed to the prolongation of life for patients with DCM.