An exploration of the association between ischemic etiology and the likelihood of heart failure hospitalization following cardiac resynchronization therapy

Abstract

Background Myocardial scarring resulting from cardiomyopathy with ischemic etiology may interfere with effective lead placement during implantation of multi‐lead cardioverter‐defibrillators for cardiac resynchronization therapy (CRT‐D). Extensive scarring is known to be associated with poorer physiological and survival outcomes in patients who undergo CRT‐D. Hypothesis Ischemic CRT‐D recipients respond as well as nonischemic recipients, using hospital admission for heart failure (HF) as a measure of response. Methods Patients who underwent CRT‐D between February 1, 2013, and February 1, 2014, were identified in an insurer's claims. Inclusion required 1 year of enrollment pre– and post–CRT‐D. The sample was divided into nonischemic and ischemic groups, and a subset of the ischemic group with a history of ST‐segment elevation myocardial infarction (STEMI) was identified. The likelihood of HF hospital admissions in the year before and after CRT‐D was computed for each group, as well as for the subset of patients with HF admissions prior to CRT‐D. Results A significant (P = 0.02) association was found between ischemic etiology and the post–CRT‐D HF admission likelihood. No association was found between history of STEMI vs nonischemic status and likelihood of post–CRT‐D HF admission. All groups had significantly lower risk of HF admissions after CRT‐D. None of the comparisons involving only patients with a HF hospitalization in the year prior to CRT‐D were significant. Conclusions Patients with nonischemic etiology were significantly less likely to experience a HF admission after CRT‐D, but the risk of HF admission improved significantly in all groups after CRT‐D.

The impacts of preoperative frailty on readmission after cardiac implantable electrical device implantation

“…Next, we conducted the Cox proportional hazards regression with one-year readmission set as the objective variable. Based on the outcomes of previous studies, we selected the following dependent variables: sex [19,20], age at implantation (divided into 75 years of age or older and less than 75 years of age [19,20]), left ventricular ejection fraction (more than 50%; heart failure with preserved ejection fraction, more than 40%, less than 50%; heart failure with mid-range ejection fraction, and less than 40%; heart failure with reduced ejection fraction [HFrEF]) [21], kidney failure (estimated glomerular filtration rate < 60%) [22], anemia (hemoglobin < 10 g/dl) [23], hyponatremia (sodium < 135 mEq/L) [24], ischemic or non-ischemic [25][26][27], type of CIED [28], type of implant, and frailty [7]. In cases where variables were significant, we created Kaplan-Meier survival curves and conducted intergroup comparisons using Kaplan-Meier estimators with log-rank tests.…”