Target doses of guideline-directed medical therapeutic agents predicts response to cardiac resynchronization therapy
Tyler J Kingma1, Hossam Albeyoumi2, Madhumita Kolluri2
1Internal Medicine, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT, 06030-1235, USA. kingma@uchc.edu.
Insights
Optimally dosed guideline-directed medical therapy (GDMT) significantly predicts response to cardiac resynchronization therapy (CRT) in heart failure with reduced ejection fraction (HFrEF) patients. Patients on 2-4 GDMT doses were more likely to respond to CRT.
Area of Science:
- Cardiology
- Heart Failure Research
- Medical Device Therapy
Background:
- Guideline-directed medical therapy (GDMT) is the standard for heart failure with reduced ejection fraction (HFrEF).
- Ventricular dyssynchrony in HFrEF patients often necessitates cardiac resynchronization therapy (CRT).
- Predicting CRT response in HFrEF patients requires further investigation.
Purpose of the Study:
- To investigate the predictive role of GDMT in patients undergoing CRT for HFrEF.
- To determine if the number of optimally dosed GDMT medications influences CRT response.
Main Methods:
- Retrospective chart review of 181 HFrEF patients who underwent CRT.
- Evaluation of individual GDMT medications for target dose achievement prior to CRT.
- Comparison of GDMT dose achievement between CRT responders and non-responders.
Main Results:
- A higher number of optimally dosed GDMT medications showed a significant trend toward CRT response (p=0.0277).
- Patients on 2-4 optimally dosed GDMT were 3.48 times more likely to be CRT responders compared to those on zero.
- No significant difference in response was observed between 0 and 1 optimally dosed GDMT therapies.
Conclusions:
- Higher numbers of optimally dosed GDMT, particularly >2 therapies, are associated with a statistically significant trend toward improved CRT response.
- Optimizing patients with as many tolerated, optimally dosed GDMT medications is recommended for enhanced CRT outcomes.
Background:
The mainstay of therapy in patients with heart failure with reduced ejection fraction (HFrEF) has long been guideline-directed medical therapy (GDMT). This is further complicated by those who have concomitant ventricular dyssynchrony due to conduction abnormalities requiring implantable cardioverter-defibrillators or cardiac resynchronization therapy (CRT). The aim in our study was to investigate the role of GDMT in predicting response to CRT.
Methods:
We performed a retrospective chart review of 181 patients at St. Francis Hospital of Trinity Health of New England and UConn John Dempsey Hospital with HFrEF diagnosis who underwent CRT between 01/01/2014 to 01/01/2024. Specifically, individual medications were evaluated as either meeting the target dose or not of GDMT prior to CRT. Then, the effect of achieving target doses was then compared in patients deemed CRT 'responders' and 'non-responders'.
Results:
Patients receiving a higher number of optimally dosed GDMT showed a significant trend (p = 0.0277) toward responding to CRT. There was no significant difference between 1 and 0 therapies (OR 1.487; 95% CI, 0.689-3.209) and between 1 and 2-4 (OR 0.427; 95% CI, 0.123-1.487). However, patients receiving 2-4 optimally dosed GDMT were 3.48 times (95% CI, 1.050-11.529) more likely to be a responder when compared to those on 0 optimally dosed therapies.
Conclusions:
There is a statistically significant trend toward responding to CRT when patients are on a higher number of optimally dosed GDMT, especially with > 2 therapies. Based on this data, patients should be optimized with as many optimally dosed medications as tolerated for improved outcomes.
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