Key result
Poor patient-reported health status prior to cardiac resynchronisation therapy implantation was independently associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death.
Why the study?
Does poor patient-reported health status prior to CRT implantation predict increased risk of cardiac hospitalisation or all-cause death in patients receiving a first-time CRT-defibrillator?
Observational (n=139)
No
Does poor patient-reported health status prior to CRT implantation predict increased risk of cardiac hospitalisation or all-cause death in patients receiving a first-time CRT-defibrillator?
Poor patient-reported health status (KCCQ < 50) prior to CRT implantation independently predicts poor survival and prolonged hospital stays, highlighting the prognostic value of health status measures.
May aid pre-CRT risk stratification; leaves open whether targeting health status improves outcomes.
BACKGROUND: Patient-reported factors have largely been neglected in search of predictors of response to cardiac resynchronisation therapy (CRT). The current study aimed to examine the independent value of pre-implantation patient-reported health status in predicting four-year survival and cardiac-related hospitalisation of CRT patients. METHODS: Consecutive patients (N = 139) indicated to receive a first-time CRT-defibrillator at the University Medical Center Utrecht were asked to complete a set of questionnaires prior to implantation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess heart failure-specific health status. Data on patients' demographic, clinical and psychological characteristics at baseline, and on cardiac-related hospitalisations and all-cause deaths during a median follow-up of 3.9 years were obtained from purpose-designed questionnaires and patients' medical records. RESULTS: Results of multivariable Cox regression analyses showed that poor patient-reported health status (KCCQ score < 50) prior to implantation was associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death, independent of sociodemographic, clinical and psychological risk factors (adjusted hazard ratio 2.46, 95 % confidence interval (CI) 1.30-4.65). Poor health status was not significantly associated with the absolute number of cardiac-related hospital admissions, but with the total number of days spent in hospital during follow-up (adjusted incidence rate ratio 3.20, 95 % CI 1.88-5.44). CONCLUSIONS: Patient-reported health status assessed prior to CRT identifies patients at risk for poor survival and prolonged hospital stays, independent of traditional risk factors. These results emphasise the importance of incorporating health status measures in cardiovascular research and patient management. Heart failure patients reporting poor health status should be identified and offered appropriate additional treatment programs.
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Versteeg et al. (2015) conducted an observational in Heart failure (n=139). Poor patient-reported health status (KCCQ score < 50) vs. Good health status (KCCQ score ≥ 50) was evaluated on First-time cardiac-related hospital admission or all-cause death (adjusted HR 2.46, 95% CI 1.30-4.65, p=0.005). Poor patient-reported health status prior to cardiac resynchronisation therapy implantation was independently associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death.
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