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The European CRT Survey: 1 year (9-15 months) follow-up results
Nigussie Bogale1, Silvia Priori, John G F Cleland
1Stavanger University Hospital, Stavanger, Norway. nigussie.bogale@lyse.net
Insights
The European CRT Survey found that most patients receiving cardiac resynchronization therapy (CRT) reported improved symptoms within a year. Outcomes, including survival and hospitalization, aligned with clinical trial data for CRT devices.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- The European CRT Survey, a joint initiative of the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA), aimed to assess contemporary cardiac resynchronization therapy (CRT) implantation practices in Europe.
- CRT is a key therapy for heart failure, but real-world data on its effectiveness and patient outcomes are crucial.
Purpose of the Study:
- To evaluate the clinical outcomes of cardiac resynchronization therapy (CRT) in a large, diverse European patient population.
- To compare real-world CRT outcomes with findings from randomized controlled trials.
- To identify factors associated with improved or poorer outcomes after CRT implantation.
Main Methods:
- An observational study involving 2438 patients who underwent successful CRT implantation across 141 centers in 13 European countries.
- Data collected included baseline demographics, clinical status, implantation details, and clinical outcomes (symptom severity, cardiovascular hospitalization, survival) at approximately 1-year follow-up.
- Follow-up data were obtained from 2111 patients (87% of the enrolled cohort).
Main Results:
- 81% of patients reported symptom improvement (NYHA class) at 1-year follow-up, with 16% reporting no change and 4% deterioration.
- Overall, 10% of patients died, 16% were hospitalized for cardiovascular reasons, and 24% experienced either death or cardiovascular hospitalization.
- Factors associated with poorer survival included worse NYHA class, atrial fibrillation, ischemic heart disease, and CRT-P devices; women and those receiving CRT-D had better outcomes.
Conclusions:
- Clinical outcomes, including mortality and hospitalization rates, in the European CRT Survey were comparable to those reported in clinical trials.
- The majority of patients perceived a significant improvement in their condition one year after CRT implantation.
- While this observational study focused on successful implantations, subgroup analyses should be interpreted cautiously.
Aims:
The European CRT Survey is a joint initiative of the Heart Failure Association (HFA) and the European Heart Rhythm Association (EHRA) of the European Society of Cardiology evaluating the contemporary implantation practice of cardiac resynchronization therapy (CRT) in Europe.
Methods And Results:
Patients who had a successful CRT implantation were enrolled from 141 centres in 13 countries between November 2008 and June 2009. Baseline demographics, clinical and implantation data were collected, with a follow-up of ∼1 year (9-15 months). The current report describes clinical outcomes including symptom severity, cardiovascular (CV) hospitalization, and survival. A total of 2438 patients were enrolled, and follow-up data were acquired from 2111 patients (87%). The population included important groups of patients poorly represented in randomized controlled trials, including very elderly patients and those with prior device implantation, atrial fibrillation, and/or QRS duration <120 ms. Investigators reported substantial improvement in New York Heart Association (NYHA) functional class at follow-up. Patient self-assessment indicated that 81% of the patients felt improved, 16% reported no change, and 4% reported deterioration. During follow-up, 207 (10%) patients died, 346 (16%) had a CV hospitalization, and 501 (24%) died or had CV hospitalization. Worse NYHA functional class, atrial fibrillation, ischaemic aetiology, and device type (CRT-P, i.e. CRT alone) were associated with poorer survival. Women had a better outcome, as did patients who had a CRT-D (with an implantable cardioverter defibrillator function) device.
Conclusions:
Outcomes including death and hospitalization in this European CRT survey were consistent with results from clinical trials of CRT. At 1 year follow-up, most patients who received a CRT device considered their symptoms improved compared with their pre-implant assessment. Although prospective, this is an observational study of successful CRT implantations, and outcomes in subgroup analyses must be interpreted with appropriate conservatism.
