Mortality risk lower for patients with mild HF stabilized early with CRT
Patients with mild HF on cardiac resynchronization therapy had lower risk for mortality if they improved or stabilized on CRT compared with if they worsened, researchers reported.
In an analysis from the REVERSE trial of 406 patients surviving 1 year with mild HF (mean age, 63 years; 78% men), Michael R. Gold, MD, PhD, professor in the department of medicine at the Medical University of South Carolina, Charleston, and colleagues classified patients as improved, stabilized or worsened through prespecified criteria based on the clinical composite score and change in left ventricular end-systolic volume index and compared mortality across CRT at 5 years.
“The definitions of responder are arbitrary and the cutoffs not founded in clinical data,” Gold told Healio. “The natural history of congestive heart failure is continued progression, so stabilization is an improvement.”
Researchers observed a difference in 5-year survival between clinical composite score subgroups (P = .03). The worsened response subgroup had elevated mortality compared with the combined improved and stabilized subgroups (21% vs. 10%; P = .01). A total of 353 patients (mean age, 63 years; 77% men) had adequate echocardiograms defining LV end-systolic volume index, with 52% of patients improved, 23% stabilized and 25% worsened. Survival was different between all three response groups (P < .001) due to increased mortality in the worsened subgroup.
The relative 5-year mortality rate was 73% higher in patients who had worsened response and worse LV end-systolic volume index compared with those who had improved or stabilized response and similar or better LV end-systolic volume index (8% vs. 30%; P < .01), the researchers wrote.
LV end-systolic volume index worsening with CRT at 6 months and at baseline were independent predictors of survival, and female sex was a predictor for reduced mortality in the multivariate analyses.
“Cardiac resynchronization therapy should not be abandoned if patients do not get better. The true nonresponder rate is likely much lower than stated,” Gold told Healio. “If validated in further studies, then the guidelines are likely to change on their next iteration.”
For more information:
Michael R. Gold, MD, PhD, can be reached at goldmr@musc.edu.
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