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Prophylactic pacemaker use to allow beta-blocker therapy in patients with chronic heart failure with bradycardia

Eric C Stecker1, A Mark Fendrick, Bradley P Knight

  • 1Division of General Medicine, University of Michigan, Ann Arbor, MI, USA.

American Heart Journal
|March 30, 2006
PubMed

Insights

Prophylactic pacemaker insertion can help patients with congestive heart failure (CHF) and low heart rates receive beta-blocker therapy. This approach is clinically beneficial and highly cost-effective for improving survival.

Area of Science:

  • Cardiology
  • Medical Economics

Background:

  • Patients with congestive heart failure (CHF) and low resting heart rates are often excluded from beta-blocker therapy, despite its proven benefits.
  • Beta-blocker therapy benefits for CHF are independent of pretreatment heart rate.

Purpose of the Study:

  • To investigate the effectiveness and cost-effectiveness of prophylactic pacemaker insertion to facilitate beta-blocker use in patients with CHF and low heart rates.

Main Methods:

  • A Markov model simulated the natural history of stable CHF patients (ejection fraction ≤35%, mean age 60) with resting heart rates <68 bpm.
  • Two strategies were compared: conventional therapy and pacemaker insertion with atrial pacing and carvedilol therapy.
  • Risk reductions for death and hospitalizations with carvedilol were derived from the US Carvedilol Heart Failure Study.

Main Results:

  • The pacemaker-carvedilol strategy increased mean survival by 1.3 years.
  • The incremental cost was $7800, yielding an incremental cost-effectiveness of $6100 per year of life saved.
  • Sensitivity analyses showed results were most affected by pacing-induced harm, hospitalization costs, and reduced beta-blocker benefits.

Conclusions:

  • Prophylactic pacemaker insertion to enable beta-blocker treatment in CHF patients with low resting heart rates can be clinically beneficial.
  • This strategy has the potential to be highly cost-effective for improving patient outcomes.
Abstract

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