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Echocardiographic screening for heart failure and optimization of the care pathway for individuals with pacemakers: a
Maria F Paton1,2, John Gierula1, Haqeel A Jamil1
1Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Insights
Echocardiography screening for left ventricular systolic dysfunction (LVSD) in pacemaker patients did not significantly reduce heart failure hospitalizations or death. Specialist clinic management showed a trend toward better outcomes in patients with LVSD.
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Imaging
Background:
- Pacemaker recipients face a higher risk of left ventricular systolic dysfunction (LVSD).
- The clinical benefit of screening for and optimizing LVSD management in pacemaker patients remains uncertain.
Purpose of the Study:
- To evaluate if echocardiography screening and optimized medical management of LVSD improve clinical outcomes in pacemaker patients.
Main Methods:
- A multicenter controlled trial (OPT-PACE) randomized 1,201 pacemaker patients to echocardiography screening or usual care.
- The primary outcome was the composite of time to first heart failure hospitalization or death.
- LVSD detection in the screening arm led to management in primary care or a specialist heart failure and devices clinic.
Main Results:
- LVSD was detected in 34% of patients in the screening arm.
- No significant difference in the primary outcome was observed between the echocardiography screening group (18%) and the usual care group (19%) over a median follow-up of 31 months.
- An exploratory analysis suggested a potential benefit for LVSD management within a specialist clinic compared to primary care.
Conclusions:
- Echocardiography screening frequently identifies LVSD in pacemaker patients.
- Screening alone did not significantly improve clinical outcomes in this population.
- Specialist management may offer a benefit for LVSD patients, warranting further investigation.
Abstract:
Individuals with pacemakers are at increased risk of left ventricular systolic dysfunction (LVSD). Whether screening for and optimizing the medical management of LVSD in these individuals can improve clinical outcomes is unknown. In the present study, in a multicenter controlled trial (OPT-PACE), we randomized 1,201 patients (717 men) with a pacemaker to echocardiography screening or usual care. In the screening arm, LVSD was detected in 201 of 600 (34%) patients, who then received management in either primary care or a specialist heart failure (HF) and devices clinic. The primary outcome of the trial was the difference in a composite of time to first HF hospitalization or death. Over 31 months (interquartile range = 30-40 months), the primary outcome occurred in 106 of 600 (18%) patients receiving echocardiography screening, which was not significantly different compared with the occurrence of the primary outcome in 115 of 601 (19%) patients receiving the usual care (hazard ratio = 0.89; 95% confidence interval = 0.69, 1.17). In a prespecified, nonrandomized, exploratory analysis, patients with LVSD managed by the specialist clinic experienced the primary outcome event less frequently than those managed in primary care. The results of this trial indicate that echocardiography screening commonly identifies LVSD in individuals with pacemakers but alone does not alter outcomes. ClinicalTrials.gov registration: NCT01819662 .
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