Cardiac resynchronization therapy outcomes in patients under nonoptimal medical therapy
Belén Alvarez-Alvarez1, Javier García-Seara2, Jose L Martínez-Sande2
1Cardiology Department Clinical University Hospital of Santiago de Compostela Santiago de Compostela Spain.
Insights
Optimal medical therapy (OMT) before cardiac resynchronization therapy (CRT) did not improve outcomes. However, achieving OMT within a year after CRT significantly reduced heart failure (HF) events and death in patients.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Cardiac resynchronization therapy (CRT) is a standard treatment for symptomatic heart failure (HF) patients.
- Optimal medical therapy (OMT) is typically recommended before CRT implantation.
- Many patients do not receive OMT before CRT, necessitating an evaluation of OMT's impact on CRT outcomes.
Purpose of the Study:
- To assess the long-term effects of OMT on heart failure (HF) development or death in patients undergoing CRT.
- To compare outcomes between patients receiving OMT at different time points relative to CRT implantation.
Main Methods:
- A cohort of 328 patients receiving CRT between 2005 and 2015 was analyzed.
- Patients were categorized based on OMT status: no OMT, OMT at baseline and 1-year follow-up, or OMT only at 1-year follow-up.
- Multivariate Cox proportional hazards models were used to evaluate the association between OMT and clinical outcomes.
Main Results:
- OMT at baseline was not significantly associated with a reduced risk of death or HF compared to no OMT.
- Patients without OMT after CRT showed a higher risk of death or HF compared to those who achieved OMT during follow-up.
- Patients achieving OMT at 1-year follow-up had similar outcomes to those receiving OMT at baseline and 1-year follow-up.
Conclusions:
- Initiating OMT before CRT implantation does not appear to improve HF/death outcomes.
- Achieving OMT within one year post-CRT is associated with a reduced risk of HF and death.
- Timing of OMT relative to CRT is crucial for optimizing patient outcomes.
Background:
Cardiac resynchronization therapy (CRT) is indicated in symptomatic heart failure (HF) patients after achieving optimal medical therapy (OMT). However, many patients may not be under OMT when the CRT device is implanted. Here, we evaluate the long-term benefits of CRT in symptomatic HF patients receiving or not OMT.
Methods:
We investigated the effect of OMT on HF developing or death in 328 consecutive patients with a CRT device implanted between 2005 and 2015 in a single tertiary center. After the CRT implant, we categorized the patients into three groups: no OMT, OMT at baseline and after 1 year of follow-up, and OMT only at the 1-year follow-up but not at baseline. We used multivariate Cox proportional hazards model to determine the effect of OMT on clinical outcomes.
Results:
One hundred and twenty-two patients (37.2%) received OMT prior to CRT. OMT at baseline was not associated with a reduced risk of death or HF (HR 0.72; 95% CI 0.50-1.02; P = 0.067) compared with no-basal-OMT patients. After CRT, patients without OMT had a higher risk of death or HF than patients who received OMT in follow-up (HR 1.72, 95% CI 1.07-2.78, P = 0.025), and the risk of the patients who received OMT at baseline and at the 1-year follow-up was similar to that of the patients who achieved OMT at the 1-year follow-up (HR 0.90, 95% CI 0.54-1.50, P = 0.682).
Conclusion:
Basal OMT prior to CRT is not associated with better outcomes in terms of HF/death compared with no basal OMT. The subgroup of patients who achieved OMT at the 1-year follow-up exhibited a reduced risk of HF and death compared with patients who did not.
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