Improved prognosis after cardiac resynchronization therapy over a decade.
Francisco Leyva1, Abbasin Zegard1,2, Peysh Patel2
1Aston Medical Reseach Insitute, Aston Medical School, Aston University, Aston Triangle, Birmingham B4 7ET, UK.
Summary
Cardiac resynchronization therapy (CRT) improved survival and reduced heart failure hospitalizations over the past decade in England. These positive outcomes for CRT patients occurred despite a rise in patient comorbidities.
Area of Science:
- Cardiology
- Public Health
- Medical Device Technology
Background:
- Cardiac resynchronization therapy (CRT) delivery has increased significantly for heart failure (HF) patients over the last decade.
- Understanding the impact of CRT on clinical outcomes within a public healthcare system is crucial for resource allocation and patient care.
Purpose of the Study:
- To evaluate changes in clinical outcomes following CRT implantation from 2010 to 2019.
- To assess the impact of an increasing patient comorbidity burden on CRT effectiveness within a national healthcare system.
Main Methods:
- Analysis of a national database of 64,698 patients undergoing CRT implantation (CRT-defibrillation or CRT-pacing) in England between 2010 and 2019.
- Examination of trends in CRT implantation rates, patient demographics, comorbidities (hypertension, diabetes, chronic kidney disease), and Charlson Comorbidity Index (CCI).
- Statistical analysis of 30-day, 1-year, and 2-year mortality rates, and mortality or HF hospitalization, with adjustments for multiple clinical factors.
Main Results:
- CRT implantations increased by 76% from 2010-2011 to 2018-2019.
- The prevalence of key comorbidities (hypertension, diabetes, chronic kidney disease) and a higher CCI (≥3) significantly increased among patients receiving CRT.
- Despite the rising comorbidity burden, significant reductions were observed in 30-day mortality (1.43% to 1.09%), 1-year mortality (9.51% to 8.13%), and 2-year mortality or HF hospitalization (HR: 0.59).
Conclusions:
- CRT implantation has led to improved survival and reduced heart failure hospitalizations over the past decade within the English public health system.
- The prognostic benefits of CRT have been maintained despite a notable increase in the complexity of patient comorbidities.
- These findings underscore the sustained value of CRT in managing heart failure patients within a large-scale healthcare setting.
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