How many patients with heart failure are eligible for cardiac contractility modulation therapy?

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Rajdip Dulai1, Ahmed Chilmeran1, Mazin Hassan1

  • 1Cardiology Research Department, East Sussex Hospitals NHS Trust, Eastbourne District General Hospital, Eastbourne, UK.

International Journal of Clinical Practice
|August 7, 2020
PubMed

Insights

Only 5.1% of heart failure patients meet criteria for cardiac contractility modulation (CCM) therapy. This small group, however, lacks alternative device options for their condition.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac contractility modulation (CCM) therapy shows promise for improving heart failure symptoms.
  • Patient selection is crucial for successful CCM therapy outcomes.
  • Current criteria aim to identify heart failure patients most likely to benefit.

Purpose of the Study:

  • To determine the proportion of unselected heart failure patients eligible for CCM therapy.
  • To analyze the characteristics of patients meeting CCM criteria.
  • To assess the potential impact of CCM therapy on a broader heart failure population.

Main Methods:

  • Retrospective audit of 475 heart failure admissions in UK district general hospitals (2018).
  • Evaluation of patients against established CCM selection criteria: ejection fraction (25-45%), QRS duration (<130 ms), NYHA class (3-4), and stable medication for ≥90 days.
  • Exclusion criteria included significant valvular disease, atrial fibrillation, and palliative care intent.

Main Results:

  • Only 5.1% (24/475) of audited patients met the criteria for CCM therapy.
  • Eligible patients had a mean ejection fraction of 32.5% ± 7.4% and were predominantly male (71%) with ischemic cardiomyopathy (75%).
  • Inclusion of patients with atrial fibrillation could increase eligibility by an additional 3.8%.

Conclusions:

  • Cardiac contractility modulation therapy is currently suitable for a small fraction (5.1%) of the general heart failure population.
  • Despite low numbers, these patients represent a group with limited alternative device-based treatment options.
  • Further research may explore expanding CCM eligibility criteria or alternative therapies for heart failure patients.
Abstract

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