Real-world clinical burden among patients with and without heart failure worsening after cardiac resynchronization therapy. (2nd September 2022)

• Record Type: Journal Article
• Authors: Chung, Eugene S.; Rickard, John; Lu, Xiaoxiao; DerSarkissian, Maral; Zichlin, Miriam L.; Cheung, Hoi Ching; Swartz, Natalia; Greatsinger, Alexandra; Duh, Mei S.
• Is Part Of: Current medical research and opinion. Volume 38:Number 9(2022)
• Page Start: 1489
• Page End: 1498
• Publication Date: 2022-09-02
• Subjects: Cardiac resynchronization therapy -- cardiovascular complication -- heart failure -- heart failure worsening; Clinical medicine -- Periodicals; Therapeutics -- Periodicals; 615.5
• DOI: 10.1080/03007995.2022.2092374
• Languages: English
• ISSNs: 0300-7995

Abstract

Abstract: Objective: Cardiac resynchronization therapy (CRT) can improve cardiac function in patients with heart failure (HF); however, in some patients, HF worsens despite CRT. This study characterized the long-term clinical burden of patients with and without HF worsening (HFW) within 6 months post CRT implantation. Methods: A claims database (2007–2018) was used to identify two cohorts of adults: those with HFW within 180 days post-CRT and those with no HFW (NHFW). The evaluated clinical outcomes were cardiovascular events/complications, HF-related interventions, hospice enrollment, and all-cause mortality. Inverse probability of treatment weighting (IPTW) was used to adjust for confounders; adjusted comparisons were assessed using weighted Cox proportional hazard ratios (HRs). Results: Among the 12, 753 adults analyzed (HFW: N = 4, 785; NHFW: N = 7, 968), the mean age was 72 years and the mean duration of follow-up was approximately 2 years. The clinical burden was greater for HFW than for NHFW in terms of all-cause mortality (19.7% vs. 12.1%) and occurrence of atrial fibrillation (57.4% vs. 51.2%). In the IPTW-adjusted Cox proportional hazard analyses, patients with HFW had a 54% higher average hazard of experiencing all-cause mortality compared to NHFW (adjusted average HR = 1.54, 95% confidence interval [CI]: 1.41–1.70; p < .001). Of the clinical events experienced by ≥5% of patients, the greatest differences in average hazard were for HF decompensation (adjusted average HR = 1.83, 95% CI: 1.60–2.09) and HF decompensation or death (HR = 1.63, 95%CI: 1.50–1.77). Conclusion: Patients with early HFW post-CRT experienced a significantly higher clinical burden than those without HFW. Vigilance for signs of worsening HF in the first 6 months post-CRT is warranted.