Real-world clinical burden among patients with and without heart failure worsening after cardiac resynchronization
Eugene S Chung1, John Rickard2, Xiaoxiao Lu3
1The Lindner Clinical Research Center at The Christ Hospital, Cincinnati, OH, USA.
Insights
Patients experiencing heart failure worsening (HFW) within six months of cardiac resynchronization therapy (CRT) face significantly higher long-term clinical burdens, including increased mortality. Early detection of HFW post-CRT is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Cardiac resynchronization therapy (CRT) offers benefits for heart failure (HF) patients.
- A subset of patients experience worsening heart failure (HFW) despite CRT.
- Understanding the long-term clinical impact of early HFW post-CRT is essential.
Purpose of the Study:
- To characterize the long-term clinical burden in patients with and without HFW within 6 months of CRT implantation.
- To compare outcomes between patients who experienced early HFW and those who did not.
Main Methods:
- Retrospective cohort study using a claims database (2007-2018).
- Identified adult patients with and without HFW within 180 days post-CRT.
- Evaluated clinical outcomes including cardiovascular events, HF interventions, hospice, and mortality.
- Used inverse probability of treatment weighting (IPTW) for confounder adjustment and Cox proportional hazard models.
Main Results:
- Analyzed 12,753 adults (HFW: 4,785; NHFW: 7,968); mean age 72 years, follow-up ~2 years.
- HFW cohort showed higher all-cause mortality (19.7% vs. 12.1%) and atrial fibrillation (57.4% vs. 51.2%).
- Adjusted analyses revealed significantly higher hazard of all-cause mortality in HFW patients (aHR=1.54).
- Greatest hazard differences observed for HF decompensation (aHR=1.83) and HF decompensation or death (aHR=1.63) in HFW patients.
Conclusions:
- Early HFW post-CRT is associated with a substantially greater long-term clinical burden.
- Patients with early HFW face increased risks of mortality and cardiovascular complications.
- Close monitoring for HFW in the initial 6 months post-CRT is strongly recommended.
Objective:
Cardiac resynchronization therapy (CRT) can improve cardiac function in patients with heart failure (HF); however, in some patients, HF worsens despite CRT. This study characterized the long-term clinical burden of patients with and without HF worsening (HFW) within 6 months post CRT implantation.
Methods:
A claims database (2007-2018) was used to identify two cohorts of adults: those with HFW within 180 days post-CRT and those with no HFW (NHFW). The evaluated clinical outcomes were cardiovascular events/complications, HF-related interventions, hospice enrollment, and all-cause mortality. Inverse probability of treatment weighting (IPTW) was used to adjust for confounders; adjusted comparisons were assessed using weighted Cox proportional hazard ratios (HRs).
Results:
Among the 12,753 adults analyzed (HFW: N = 4,785; NHFW: N = 7,968), the mean age was 72 years and the mean duration of follow-up was approximately 2 years. The clinical burden was greater for HFW than for NHFW in terms of all-cause mortality (19.7% vs. 12.1%) and occurrence of atrial fibrillation (57.4% vs. 51.2%). In the IPTW-adjusted Cox proportional hazard analyses, patients with HFW had a 54% higher average hazard of experiencing all-cause mortality compared to NHFW (adjusted average HR = 1.54, 95% confidence interval [CI]: 1.41-1.70; p < .001). Of the clinical events experienced by ≥5% of patients, the greatest differences in average hazard were for HF decompensation (adjusted average HR = 1.83, 95% CI: 1.60-2.09) and HF decompensation or death (HR = 1.63, 95%CI: 1.50-1.77).
Conclusion:
Patients with early HFW post-CRT experienced a significantly higher clinical burden than those without HFW. Vigilance for signs of worsening HF in the first 6 months post-CRT is warranted.
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