Cardiac resynchronization therapy is associated with improvement in clinical outcomes in Indian heart failure patients: Results of a large, long-term observational study

Abstract

BackgroundHeart failure (HF) is a common health problem in South Asia, and its incidence and prevalence are projected to rise. Cardiac resynchronization therapy (CRT) has been shown to improve mortality, reduce hospitalizations, and improve symptoms in selected patients with HF. The South Asian Systolic Heart Failure Registry (SASHFR) was designed to be a large and comprehensive registry of Indian HF patients with the purpose of enhancing the quality of care and clinical outcomes of HF patients by promoting the adoption of evidence-based, guideline-recommended therapies, in particular CRT.MethodsOverall, 471 patients on optimized medical therapy and meeting CRT implantation guidelines were followed up in 12 Indian hospitals. During the 2-year follow-up period, clinical response in terms of clinical composite score, overall performance and changes in HF performance metrics, mortality and hospitalizations rates were evaluated.ResultsOf 471 patients, 116 (24.6%) accepted to be implanted with a CRT device, while 355 (75.4%) refused, financial constraints being the main reason for refusing a CRT device. The study met its primary outcome, as the number of patients associated with an improvement in clinical composite score at 24 months was significantly higher (69.1%) in the CRT group than in the no-CRT group (44.7%) [odds ratio = 2 (95% confidence interval 1.25–3.20), p = 0.004]. Also, changes in HF metrics, mortality and hospitalizations rates indicated a more favorable response among patients who underwent CRT.ConclusionsThe results from the SASHFR registry show a clear superiority of CRT over optimal pharmacological therapy in terms of improvement in clinical conditions among HF patients. The low rate of CRT acceptance, in patients indicated to this therapy, highlights the need for new health-care policies to improve awareness about HF disease and its therapies and possibly to enhance financial coverage of indicated therapies.

Respondent or non-respondent comparison post cardiac resynchronisation therapy implantation in patients with dilated cardiomyopathy

“…In a study conducted by Naik et al in India, it was found that CRT treatment shows a significant improvement in the clinical conditions of the patients compared to other pharmacological interventions. 9 Particularly, the dyssynchrony parameters including SPWMD, LVEMD and IVD significantly improved after CRTD implantation.…”

Left bundle branch pacing–optimized implantable cardioverter-defibrillator (LOT-ICD) for cardiac resynchronization therapy: A pilot study

“…In a large, long-term observational study of Indian heart failure patients, out of 471 enrolled patients only 24.6% opted for cardiac resynchronization therapy–pacemaker/CRT-D; in the remaining 75.4% of patients, financial constraints were the main reason for therapy refusal. 8 With conduction system pacing providing complete correction of wide QRS, LBBP would obviate the need for CS lead placement. The additional cost, procedural duration, poor venous anatomy, phrenic nerve capture, high capture threshold, and lead dislodgments associated with CS lead placement could be addressed by complete correction of conduction system disease by LBBP.…”

Correlation of newer indices of dyssynchrony with clinical response in patients undergoing cardiac resynchronisation therapy

“…There has been some evidence to suggest that there is a weak correlation between electrical and mechanical dyssynchrony inpredicting subsequent benefit of CRT. 2 One third of patients with prolonged QRS do not exhibit intra-left ventricular (LV) dyssynchrony, 1 , 2 , 3 which may explain reasons for non-response. This study evaluates baseline echocardiographic parameters of dyssynchrony in patients undergoing CRT implantation and their evolution after CRT on follow up.…”