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How to improve outcomes: should we put more emphasis on programming and medical care and less on patient selection?
1Department of Academic Cardiology, Castle Hill Hospital, University of Hull, Cottingham, HU16 5JQ, UK. drlbuga@gmail.com
Insights
Cardiac resynchronization therapy (CRT) can improve heart failure (HF) symptoms and survival. However, persistent symptoms after CRT require further investigation and management strategies for optimal patient outcomes.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Heart failure (HF) is a complex condition with multifactorial pathophysiology.
- Guideline-directed medical therapy is standard for HF management.
- Cardiac resynchronization therapy (CRT) offers benefits for select HF patients with prolonged QRS duration.
Purpose of the Study:
- To review the reasons for persistent or recurrent symptoms in patients with HF after CRT implantation.
- To summarize evidence on identifying and treating these symptoms.
- To guide clinical management for improved patient outcomes.
Main Methods:
- Literature review of studies on CRT in heart failure.
- Analysis of factors contributing to suboptimal CRT response.
- Synthesis of evidence on managing persistent symptoms post-CRT.
Main Results:
- Persistent symptoms after CRT can stem from disease progression, comorbidities, or device issues.
- Suboptimal device programming is a common and treatable cause of CRT failure.
- Addressing underlying causes is crucial for managing refractory HF symptoms.
Conclusions:
- Careful patient selection and device optimization are key for CRT success.
- Investigating and managing persistent symptoms post-CRT is essential for improving quality of life and prognosis.
- Further research is needed to refine CRT strategies and address refractory cases.
Abstract:
Many factors contribute to the pathophysiology and progression of heart failure (HF), offering the potential for many synergistic therapeutic approaches to its management. For patients, who have systolic HF, prolonged QRS and receiving guideline-indicated pharmacological therapy, cardiac resynchronization therapy (CRT) may provide additional benefits in terms of symptom improvement and mortality reduction. Nevertheless, in many patients, moderate or severe symptoms may persist or recur after CRT implantation due to either the severity or progression of the underlying disease, the presence of important co-morbidities or suboptimal device programming. Identifying and, where possible, treating the reasons for persistent or recurrent symptoms in patients who have received CRT is an important aspect of patient care. The present review summarizes the available evidence on this topic.
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