Impact of cardiac resynchronization therapy optimization inside a heart failure programme: a real-world experience

Area of Science:

• Cardiology
• Heart Failure Management
• Medical Device Technology

Background:

• Cardiac Resynchronization Therapy (CRT) is a treatment for heart failure (HF) that can improve symptoms and outcomes.
• However, a significant portion of patients do not respond to CRT, necessitating optimization strategies.
• In-hospital CRT programs aim to improve patient management and device efficacy.

Purpose of the Study:

• To evaluate the impact of a routine in-hospital CRT program.
• To assess the effectiveness of comprehensive HF evaluation and echo-guided CRT optimization.
• To identify factors influencing CRT response and outcomes.

Main Methods:

• A cohort of 227 CRT-implanted patients underwent an optimization program 3-12 months post-implantation.
• The program included clinical/biological assessment, screening for non-response causes, and echo-guided optimization of atrioventricular (AVd) and interventricular delays (VVd).
• Clinical response was assessed using a composite score (CCS) at 6 months, and major HF events were tracked for 1 year.

Main Results:

• Of 227 patients, 111 (48.9%) were initial non-responders.
• Among 196 patients optimized, 36.2% required VVd modification and 34.7% required AVd modification.
• At 6 months, 34.3% of initial non-responders improved, but AVd/VVd modifications were not significantly linked to CCS improvement. Initial non-responders had more HF events over 1 year.

Conclusions:

• A close, comprehensive, and multidisciplinary follow-up is essential for CRT patients.
• The study does not advocate for the routine use of echo-guided CRT optimization.
• Further research may be needed to refine CRT optimization strategies for non-responders.