The prognostic significance of pharmacological therapy after cardiac resynchronization therapy

Pharmacological therapy is essential in heart failure with reduced ejection fraction (HFrEF), but its prognostic role at the time of cardiac resynchronization therapy (CRT) remains uncertain.

We retrospectively studied 272 patients (mean age 66 years;72% male) who underwent CRT between 2005 and 2023. Pharmacological therapy was assessed only at baseline. Medication included β-blockers (97.4%), renin-angiotensin system inhibitors or angiotensin receptor-neprilysin inhibitors (RAS inhibitors/ARNIs, 81.3%), mineralocorticoid receptor antagonists (64.7%), and loop diuretics (76.8%). The primary outcome was cardiac death or left ventricular assist device (LVAD) implantation. Cox models evaluated associations between baseline medication use, medication doses, and outcomes.

During a median follow-up of 4.2 years, 126 patients (46.3%) experienced the primary outcome. Baseline use and higher β-blocker dose were independently associated with a lower risk of the primary outcome. RAS inhibitors/ARNIs use was also associated with a lower risk of cardiac death or LVAD implantation. In contrast, higher loop diuretic dose and inotrope use tended to be associated with worse outcomes.

Baseline use and dosing of β-blockers and RAS inhibitors/ARNIs were prognostically significant in CRT recipients, underscoring the importance of optimizing pharmacotherapy at the time of device implantation.