Multidisciplinary recommendations for CRT optimization were associated with fewer adverse events compared to no recommendations (13% vs. 50%; OR 0.2; 95% CI 0.07-0.56; p=0.002).
Cohort (n=75)
Odds Ratio: 0.2 (95% CI 0.07–0.56)
Absolute Event Rate: 13% vs 50%
p-value: p=0.002
OBJECTIVES: Our aim was to determine the feasibility and value of a protocol-driven approach to patients with cardiac resynchronization therapy (CRT) who did not exhibit a positive response long after implant. BACKGROUND: Up to one-third of patients with advanced heart failure do not exhibit a positive response to CRT. METHODS: A total of 75 consecutive ambulatory patients with persistent advanced heart failure symptoms and/or adverse reverse remodeling and CRT implanted >6 months underwent a comprehensive protocol-driven evaluation to determine the potential reasons for a suboptimal response. Recommendations were made to maximize the potential of CRT, and adverse events were documented. RESULTS: All patients (mean left ventricular LV ejection fraction 23 +/- 9%, LV end-diastolic volume 275 +/- 127 ml) underwent evaluation. Eighty-eight percent of patients had significantly better echocardiographic indexes of LV filling and LV ejection with optimal setting of their CRT compared with a temporary VVI back-up setting. Most patients had identifiable reasons for suboptimal response, including inadequate device settings (47%), suboptimal medical treatment (32%), arrhythmias (32%), inappropriate lead position (21%), or lack of baseline dyssynchrony (9%). Multidisciplinary recommendations led to changes in device settings and/or other therapy modifications in 74% of patients and were associated with fewer adverse events (13% vs. 50%, odds ratio: 0.2 95% confidence interval: 0.07 to 0.56, p = 0.002) compared with those in which no recommendation could be made. CONCLUSIONS: Routine protocol-driven approach to evaluate ambulatory CRT patients who did not exhibit a positive response is feasible, and changes in device settings and/or other therapies after multidisciplinary evaluation may be associated with fewer adverse events.
“Approximately one-third of patients who have a CRT device implanted to manage their heart failure do not respond or have suboptimal responses. It is these patients who may benefit the most from the focused, multidisciplinary assessment and management of the collaborative group of advanced heart failure specialists and cardiac electrophysiologists at the new UPMC HVI CRT-HF Clinic.”
Müllens et al. (2009) conducted a cohort in Advanced heart failure with suboptimal response to cardiac resynchronization therapy (CRT) (n=75). Multidisciplinary recommendations (changes in device settings and/or other therapy modifications) vs. No recommendation could be made was evaluated on Adverse events (OR 0.2, 95% CI 0.07-0.56, p=0.002). Multidisciplinary recommendations for CRT optimization were associated with fewer adverse events compared to no recommendations (13% vs. 50%; OR 0.2; 95% CI 0.07-0.56; p=0.002).