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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Response to cardiac resynchronization therapy: is it time to expand the criteria?
Henneke Versteeg1, Angélique A Schiffer, Jos W Widdershoven
1CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, The Netherlands.
Insights
Cardiac resynchronization therapy (CRT) improves heart failure but many patients do not respond. Current measures of CRT response neglect patient-reported outcomes and psychological factors, necessitating broader assessment criteria.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Cardiac resynchronization therapy (CRT) is a treatment for advanced congestive heart failure (CHF) patients with prolonged QRS intervals.
- While many patients benefit, 10-40% are non-responders, highlighting a gap in treatment efficacy.
- Current definitions of CRT response lack consensus and may not fully capture patient outcomes.
Purpose of the Study:
- To discuss existing definitions of CRT response and their limitations.
- To recommend expanding response criteria for better clinical utility.
- To explore the role of patient-reported outcomes and psychological factors.
Main Methods:
- Literature analysis of established CRT response measures.
- Review of case reports.
- Examination of patient-reported symptoms and quality of life.
Main Results:
- Established measures (NYHA class, echocardiographic, hemodynamic, neurohormonal) poorly correlate with patient-reported symptoms and quality of life.
- Psychological factors' impact on CRT outcomes is largely overlooked.
- Existing metrics fail to adequately represent the patient experience post-CRT.
Conclusions:
- Routinely assess patient health status post-CRT using disease-specific questionnaires.
- Investigate determinants of CRT response, including psychological factors like personality and depression.
- Improved assessment can lead to better secondary treatment and prognosis for CHF patients undergoing CRT.
Background:
Cardiac resynchronization therapy (CRT) is a promising treatment for a subgroup of patients with advanced congestive heart failure and a prolonged QRS interval. Despite the majority of patients benefiting from CRT, 10-40% of patients do not respond to this treatment and are labeled as nonresponders. Given that there is a lack of consensus on how to define response to CRT, the purpose of this viewpoint is to discuss currently used definitions and their shortcomings, and to provide recommendations as to how an expansion of the criteria for CRT response may be useful to clinicians.
Methods And Results:
Analysis of the literature and case reports indicates that the majority of established measures of CRT response, including New York Heart Association functional class and echocardiographic, hemodynamic, and neurohormonal parameters, are poor associates of patient-reported symptoms and quality of life. Moreover, the potential moderating role of psychological factors in determining health outcomes after CRT has largely been neglected.
Conclusions:
It is recommended to routinely assess health status after CRT with a disease-specific questionnaire in standard clinical practice and to examine its determinants, including psychological factors such as personality traits and depression. This may lead to improved (secondary) treatment and prognosis in CHF patients treated with CRT.
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