Timing of cardiac resynchronization therapy implantation
Francisco Leyva1, Abbasin Zegard1,2, Peysh Patel2
1Aston Medical Research Institute, Aston University, Aston Triangle, Birmingham B4 7ET, UK.
Insights
Timely cardiac resynchronization therapy (CRT) improves outcomes. Delaying CRT after a first heart failure hospitalization (HFH) significantly increases mortality and further HFH risk. Optimal CRT is without prior HFH or during the first HFH.
Area of Science:
- Cardiology
- Medical Device Technology
- Public Health
Background:
- The optimal timing for cardiac resynchronization therapy (CRT) implantation remains unclear.
- Understanding the relationship between CRT timing and patient outcomes is crucial for clinical decision-making.
Purpose of the Study:
- To investigate the long-term clinical outcomes of CRT based on the time interval from the first heart failure hospitalization (HFH) to device implantation.
- To identify the optimal timing for CRT implantation to improve patient prognosis.
Main Methods:
- Analysis of a large population database in England (2010-2019) including 64,968 patients who underwent CRT implantation.
- Quantification of clinical outcomes, including total mortality and HFH, in relation to the time from the first HFH to CRT implantation.
- Statistical adjustment for covariates to assess the independent impact of time to CRT on outcomes.
Main Results:
- Patients receiving CRT without a prior HFH or during their first HFH had better long-term outcomes compared to those with delayed implantation.
- Each year of delay from the first HFH to CRT implantation was associated with a 21% increased risk of total mortality and a 34% increased risk of HFH.
- The highest risks of total mortality and HFH were observed in patients undergoing CRT two or more years after their first HFH.
Conclusions:
- Delays in CRT implantation following a first HFH are linked to progressively worse long-term clinical outcomes.
- Performing CRT before any HFH or during the first HFH is associated with the best clinical outcomes.
- These findings suggest that earlier consideration of CRT may be beneficial for heart failure patients.
Aims:
The optimum timing of cardiac resynchronization therapy (CRT) implantation is unknown. We explored long-term outcomes after CRT in relation to the time interval from a first heart failure hospitalization (HFH) to device implantation.
Methods And Results:
A database covering the population of England (56.3 million in 2019) was used to quantify clinical outcomes after CRT implantation in relation to first HFHs. From 2010 to 2019, 64 968 patients [age: 71.4 ± 11.7 years; 48 606 (74.8%) male] underwent CRT implantation, 57% in the absence of a previous HFH, 12.9% during the first HFH, and 30.1% after ≥1 HFH. Over 4.54 (2.80-6.71) years [median (interquartile range); 272 989 person-years], the time in years from the first HFH to CRT implantation was associated with a higher risk of total mortality [hazard ratio (HR); 95% confidence intervals (95% CI)] (1.15; 95% CI 1.14-1.16, HFH (HR: 1.26; 95% CI 1.24-1.28), and the combined endpoint of total mortality or HFH (HR: 1.19; 95% CI 1.27-1.20) than CRT in patients with no previous HFHs, after co-variate adjustment. Total mortality (HR: 1.67), HFH (HR: 2.63), and total mortality or HFH (HR: 1.92) (all P < 0.001) were highest in patients undergoing CRT ≥2 years after the first HFH.
Conclusion:
In this study of a healthcare system covering an entire nation, delays from a first HFH to CRT implantation were associated with progressively worse long-term clinical outcomes. The best clinical outcomes were observed in patients with no previous HFH and in those undergoing CRT implantation during the first HFH.
Condensed Abstract:
The optimum timing of CRT implantation is unknown. In this study of 64 968 consecutive patients, delays from a first heart failure hospitalization (HFH) to CRT implantation were associated with progressively worse long-term clinical outcomes. Each year from a first HFH to CRT implantation was associated with a 21% higher risk of total mortality and a 34% higher risk of HFH. The best outcomes after CRT were observed in patients with no previous HFHs and in those undergoing implantation during their first HFH.
