Quality of Life in Cardiac Resynchronization Recipients: Association with Response and Impact on Outcome

Lenarczyk, Radosław; Jędrzejczyk-Patej, Ewa; Mazurek, Michał; Szulik, Mariola; Kowalski, Oskar; Pruszkowska, Patrycja; Sokal, Adam; Średniawa, Beata; Boidol, Joanna; Kowalczyk, Jacek; Podolecki, Tomasz; Mencel, Grzegorz; Kalarus, Zbigniew

doi:10.1111/pace.12523

Cited by 12 publications

(8 citation statements)

References 27 publications

(51 reference statements)

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“…Subjects without QoL improvement were significantly more prone to experience MACE (61% vs. 32%) and die (44% vs. 18%) within the follow-up. Unimproved QoL increased the probability of future Major Adverse Cardiovascular Event (MACE) by 2.7 times and death by 3.2 times independently from clinical and echocardiographic response 22 . In our study, we showed similar outcome prediction with the simple and easy to obtain EQ-5D questionnaire in a larger group of traditional CRT patients.…”

Section: Discussionsupporting

confidence: 69%

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Quality of life measured with EuroQol-five dimensions questionnaire predicts long-term mortality, response, and reverse remodelling in cardiac resynchronization therapy patients

et al. 2017

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AimsThere are previous studies on quality of life (QoL) in cardiac resynchronization therapy (CRT) patients; however, there are no data with the short EuroQol-five dimensions (EQ-5D) questionnaire predicting outcomes. We aimed to assess the predictive role of baseline QoL and QoL change at 6 months after CRT with EQ-5D on 5-year mortality and response.Methods and resultsIn our prospective follow-up study, 130 heart failure (HF) patients undergoing CRT were enrolled. Clinical evaluation, echocardiography, and EQ-5D were performed at baseline and at 6 months of follow–up, continued to 5 years. Primary endpoint was all-cause mortality at 5 years. Secondary endpoints were (i) clinical response with at least one class improvement in New York Heart Association without HF hospitalization and (ii) reverse remodelling with 15% reduction in left ventricular end-systolic volume at 6 months. Fifty-four (41.5%) patients died during 5 years, 85 (65.3%) clinical responders were identified, and 63 patients (48.5%) had reverse remodelling. Baseline issues with mobility were associated with lower response [odds ratio (OR) 0.36, 95% confidence interval (CI) 0.16–0.84; P = 0.018]. Lack of reverse remodelling correlated with self-care issues at baseline (OR 0.10, 95% CI 0.01–0.94; P = 0.04). Furthermore, self-care difficulties [hazard ratio (HR) 2.39, 95% CI 1.17–4.86; P = 0.01) or more anxiety (HR 1.51, 95% CI 1.00–2.26; P = 0.04) predicted worse long-term survival. At 6 months, mobility (HR 3.95, 95% CI 1.89–8.20; P < 0.001), self-care (HR 7.69, 95% CI 2.23–25.9; P = 0.001), or ≥ 10% visual analogue scale (VAS) (HR 2.24, 95% CI 1.27–3.94; P = 0.005) improvement anticipated better survival at 5 years.ConclusionEuroQol-five dimension is a simple method assessing QoL in CRT population. Mobility issues at baseline are associated with lower clinical response, whereas self-care issues predict lack of reverse remodelling. Problems with mobility or anxiety before CRT and persistent issues with mobility, self-care, and VAS scale at 6 months predict adverse outcome.

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Section: Discussionsupporting

confidence: 69%

“…Recently, Lenarczyk et al 22 published the association of QoL with response and outcome in CRT-implanted patients. Ninety-seven participants of the Triple-Site vs. Standard Cardiac Resynchronization Therapy Trial (TRUST CRT) were included.…”

Section: Discussionmentioning

confidence: 99%

Quality of life measured with EuroQol-five dimensions questionnaire predicts long-term mortality, response, and reverse remodelling in cardiac resynchronization therapy patients

et al. 2017

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“…61 These factors and the broader concept of quality of life (QoL) are relevant since they have been associated with all-cause and cardiac-related mortality in patients with an ICD [62][63][64][65] and CRTD. 66,67 Several characteristics have been associated with poorer QoL and occurrence of anxiety/depression: ICD shock therapies, type D personality, non-CRT device, younger age and female gender. Females in particular, seem to express more anxiety (connected to procedure, shock, and death) and concerns for body image while depression seems to be equally expressed among the two sexes.…”

Section: The Effect Of Gender On Cied Implanting Techniquementioning

confidence: 99%

The effects of gender on electrical therapies for the heart: procedural considerations, results and complications

et al. 2017

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Use of cardiac implantable devices and catheter ablation is steadily increasing in Western countries following the positive results of clinical trials. Despite the advances in scientific knowledge, tools development, and techniques improvement we still have some grey area in the field of electrical therapies for the heart. In particular, several reports highlighted differences both in medical behaviour and procedural outcomes between female and male candidates. Women are referred later for catheter ablation of supraventricular arrhythmias, especially atrial fibrillation, leading to suboptimal results. On the opposite females present greater response to cardiac resynchronization, while the benefit of implantable defibrillator in primary prevention seems to be less pronounced. Differences on aetiology, clinical profile, and development of myocardial scarring are the more plausible causes. This review will discuss all these aspects together with gender-related differences in terms of acute/late complications. We will also provide useful hints on plausible mechanisms and practical procedural aspects.

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“…The PROSPECT (Predictors of Response to CRT) trial found that a five-point improvement on the KCCQ in the first 6 months of CRT was associated with a 15 % lower risk of all-cause mortality during 18 months of follow-up [ 4 ]. In accordance, a sub-study of the TRUST-CRT (Triple-Site versus Standard CRT) study showed that unimproved scores on the MLHFQ in the first 6 months of CRT decreased the probability of event-free survival by 2.2 times, independent of clinical and echocardiographic response [ 5 ]. In order to enhance risk stratification of heart failure patients indicated for CRT, it is important to know the prognostic value of patient-reported health status assessed prior to implantation.…”

Section: Introductionmentioning

confidence: 98%

Patient-reported health status prior to cardiac resynchronisation therapy identifies patients at risk for poor survival and prolonged hospital stays

et al. 2015

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BackgroundPatient-reported factors have largely been neglected in search of predictors of response to cardiac resynchronisation therapy (CRT). The current study aimed to examine the independent value of pre-implantation patient-reported health status in predicting four-year survival and cardiac-related hospitalisation of CRT patients.MethodsConsecutive patients (N = 139) indicated to receive a first-time CRT-defibrillator at the University Medical Center Utrecht were asked to complete a set of questionnaires prior to implantation. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess heart failure-specific health status. Data on patients’ demographic, clinical and psychological characteristics at baseline, and on cardiac-related hospitalisations and all-cause deaths during a median follow-up of 3.9 years were obtained from purpose-designed questionnaires and patients’ medical records.ResultsResults of multivariable Cox regression analyses showed that poor patient-reported health status (KCCQ score < 50) prior to implantation was associated with a 2.5-fold increased risk of cardiac hospitalisation or all-cause death, independent of sociodemographic, clinical and psychological risk factors (adjusted hazard ratio 2.46, 95 % confidence interval (CI) 1.30–4.65). Poor health status was not significantly associated with the absolute number of cardiac-related hospital admissions, but with the total number of days spent in hospital during follow-up (adjusted incidence rate ratio 3.20, 95 % CI 1.88–5.44).ConclusionsPatient-reported health status assessed prior to CRT identifies patients at risk for poor survival and prolonged hospital stays, independent of traditional risk factors. These results emphasise the importance of incorporating health status measures in cardiovascular research and patient management. Heart failure patients reporting poor health status should be identified and offered appropriate additional treatment programs.

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Quality of Life in Cardiac Resynchronization Recipients: Association with Response and Impact on Outcome

Cited by 12 publications

References 27 publications

Quality of life measured with EuroQol-five dimensions questionnaire predicts long-term mortality, response, and reverse remodelling in cardiac resynchronization therapy patients

Quality of life measured with EuroQol-five dimensions questionnaire predicts long-term mortality, response, and reverse remodelling in cardiac resynchronization therapy patients

The effects of gender on electrical therapies for the heart: procedural considerations, results and complications

Patient-reported health status prior to cardiac resynchronisation therapy identifies patients at risk for poor survival and prolonged hospital stays

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