Contributor: Nicholas Hawkes
Who benefits from cardiac resynchronization therapy (CRT)? Studies show that among select HF patients CRT improves longevity, ventricular remodeling, and quality of life (QoL). The precision medicine approach asks the question, “Are there individual factors that predict QoL improvements?” Spertus and colleagues demonstrated that age, baseline QoL, and QRS duration predict individual QoL after CRT.
Data were obtained from CARE-HF, MIRACLE, MIRACLE-ICD, REVERSE, and RAFT that included either the Minnesota Living With Heart Failure (MLWHF) score and/or the Kansas City Cardiomyopathy Questionnaire (KCCQ). The analysis included 3,614 patients (1890 receiving CRT), average age: 65 years, 78% men, and 58% with ischemic cardiomyopathy. Older age, worse baseline QoL (using either MLWHF score or NYHA class), and longer QRS duration corresponded to significant improvements in QoL 3 months after CRT. When adjusting for QRS duration, QRS morphology did not predict QoL following CRT.
No study is perfect. QoL changes were assessed at 3 months (short follow-up). KCCQ has defined clinically-important thresholds of change, while the MLWHF score does not. Finally, CRT technology has advanced since this analysis was performed and newer devices may offer different QoL benefits.