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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
Women have better long-term prognosis than men after cardiac resynchronization therapy
Stanislava Zabarovskaja1, Fredrik Gadler, Frieder Braunschweig
1Section for Heart Failure, Department of Cardiology, Karolinska University Hospital, 17176 Stockholm, Sweden.
Insights
Cardiac resynchronization therapy (CRT) offers sustained long-term survival benefits. Women receiving CRT experienced significantly lower all-cause mortality compared to men, highlighting a potential gender-specific prognostic advantage.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Cardiac resynchronization therapy (CRT) is established for heart failure management.
- Long-term data and gender-specific outcomes for CRT are limited.
- Women are underrepresented in CRT studies.
Purpose of the Study:
- To evaluate long-term mortality and hospitalization rates after CRT.
- To investigate the prognostic impact of gender on CRT outcomes.
Main Methods:
- Retrospective analysis of 619 patients receiving CRT (1998-2008).
- Data collected from electronic records and national registries up to 2010.
- Primary endpoint: all-cause mortality. Secondary endpoint: all-cause mortality or heart failure hospitalization.
Main Results:
- Mean follow-up of 1320 days; 35% experienced all-cause mortality, 71% reached the secondary endpoint.
- 1-, 5-, and 10-year survival rates were 91%, 63%, and 39%, respectively.
- Female gender was an independent predictor of lower all-cause mortality (HR 0.44; P=0.025).
Conclusions:
- CRT demonstrates sustained favorable long-term prognosis.
- Women receiving CRT showed significantly lower all-cause mortality than men.
- Findings suggest a potential survival benefit for women undergoing CRT.
Aims:
Cardiac resynchronization therapy (CRT) improves prognosis in patients with moderate-to-severe heart failure, reduced left ventricular ejection fraction, and wide QRS complexes. However, CRT may be under-utilized in women and data on long-term follow-up are still scarce. The aim was to investigate long-term mortality and hospitalization and prognostic impact of gender after CRT.
Methods And Results:
Data on 619 consecutive patients (19% women) that received CRT at a single centre between 1998 and 2008 were collected from electronic medical records and national death and hospitalization registries up to 2010. The primary endpoint was death of any cause and the secondary endpoint was combined death of any cause or heart failure hospitalization. Over a mean follow-up of 1320 ± 786 days, 215 (35%) patients reached the primary endpoint and 437 (71%) the secondary endpoint. Overall, 1-, 5-, and 10-year survivals were 91, 63, and 39%, respectively. Female gender was the only independent predictor of all-cause mortality; hazard ratio (HR) 0.44 [95% confidence interval (CI), 0.21-0.90; P= 0.025]. Women also had a trend towards lower risk for the secondary endpoint, HR 0.68 (95% CI, 0.45-1.04; P= 0.072).
Conclusion:
In this registry analysis, patients with CRT had similarly high short-term survival to those in controlled trials, and this favourable prognosis was sustained over the long term.Women had lower all-cause mortality than men.
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