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Patient-assessed short-term positive response to cardiac resynchronization therapy is an independent predictor of long-term mortality.

Reitan, Christian; Bakos, Zoltan LU ; Platonov, Pyotr LU ; Höijer, Carl Johan LU ; Brandt, Johan LU ; Wang, Lingwei LU and Borgquist, Rasmus LU (2014) In Europace 16(11). p.1603-1609
Abstract
Cardiac resynchronization therapy (CRT) has a well-documented positive effect on mortality and heart failure morbidity. The aim of this study was to assess the long-term survival and the predictive value of self-assessed functional status on the long-term prognosis of patients treated with CRT-pacemaker (CRT-P).METHODS AND RESULTS: Data were retrospectively collected from medical records of 446 consecutive patients implanted with CRT-P at a large-volume Swedish tertiary care centre. Primary outcome was all-cause mortality, predictive variables were assessed by log-rank test and univariate cox regression. Three hundred and nine patients had reliable information available on early improvement after implantation and were included in the... (More)
Cardiac resynchronization therapy (CRT) has a well-documented positive effect on mortality and heart failure morbidity. The aim of this study was to assess the long-term survival and the predictive value of self-assessed functional status on the long-term prognosis of patients treated with CRT-pacemaker (CRT-P).METHODS AND RESULTS: Data were retrospectively collected from medical records of 446 consecutive patients implanted with CRT-P at a large-volume Swedish tertiary care centre. Primary outcome was all-cause mortality, predictive variables were assessed by log-rank test and univariate cox regression. Three hundred and nine patients had reliable information available on early improvement after implantation and were included in the multivariate analyses. The cohort was followed for a median of 79 months and was similar in baseline characteristics compared with major controlled trials. During follow-up 204 patients died, yearly mortality was 11.7%. Early improvement of self-assessed functional status was a strong independent predictor of survival [hazard ratio, HR 0.59, confidence interval (CI) 0.40-0.87, P = 0.007], together with well-known predictors; NYHA III-IV vs I-II (HR 1.66, CI 1.09-2.536, P = 0.018), age (HR 1.05, CI 1.03-1.08, P < 0.001), male gender (HR 2.0, CI 1.11-3.45, P = 0.021), and loop diuretic use (HR 4.41, CI 1.08-18.02). Patients with early improvement of self-assessed functional status had better 2-year and 5-year survival (P < 0.001).CONCLUSIONS: Real-life patient characteristics and predictors of outcome compare well with those in published prospective trials. Self-assessed functional status is a strong predictor of long-term survival, which may have implications for a more active follow-up of patients without spontaneous improvement. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Europace
volume
16
issue
11
pages
1603 - 1609
publisher
Oxford University Press
external identifiers
  • pmid:24681763
  • wos:000344657700011
  • scopus:84912048735
ISSN
1532-2092
DOI
10.1093/europace/euu058
language
English
LU publication?
yes
id
6c7fc3ad-bbf3-4faf-a31f-907f6efec131 (old id 4431513)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24681763?dopt=Abstract
date added to LUP
2014-05-02 20:12:26
date last changed
2017-07-23 03:15:50
@article{6c7fc3ad-bbf3-4faf-a31f-907f6efec131,
  abstract     = {Cardiac resynchronization therapy (CRT) has a well-documented positive effect on mortality and heart failure morbidity. The aim of this study was to assess the long-term survival and the predictive value of self-assessed functional status on the long-term prognosis of patients treated with CRT-pacemaker (CRT-P).METHODS AND RESULTS: Data were retrospectively collected from medical records of 446 consecutive patients implanted with CRT-P at a large-volume Swedish tertiary care centre. Primary outcome was all-cause mortality, predictive variables were assessed by log-rank test and univariate cox regression. Three hundred and nine patients had reliable information available on early improvement after implantation and were included in the multivariate analyses. The cohort was followed for a median of 79 months and was similar in baseline characteristics compared with major controlled trials. During follow-up 204 patients died, yearly mortality was 11.7%. Early improvement of self-assessed functional status was a strong independent predictor of survival [hazard ratio, HR 0.59, confidence interval (CI) 0.40-0.87, P = 0.007], together with well-known predictors; NYHA III-IV vs I-II (HR 1.66, CI 1.09-2.536, P = 0.018), age (HR 1.05, CI 1.03-1.08, P &lt; 0.001), male gender (HR 2.0, CI 1.11-3.45, P = 0.021), and loop diuretic use (HR 4.41, CI 1.08-18.02). Patients with early improvement of self-assessed functional status had better 2-year and 5-year survival (P &lt; 0.001).CONCLUSIONS: Real-life patient characteristics and predictors of outcome compare well with those in published prospective trials. Self-assessed functional status is a strong predictor of long-term survival, which may have implications for a more active follow-up of patients without spontaneous improvement.},
  author       = {Reitan, Christian and Bakos, Zoltan and Platonov, Pyotr and Höijer, Carl Johan and Brandt, Johan and Wang, Lingwei and Borgquist, Rasmus},
  issn         = {1532-2092},
  language     = {eng},
  number       = {11},
  pages        = {1603--1609},
  publisher    = {Oxford University Press},
  series       = {Europace},
  title        = {Patient-assessed short-term positive response to cardiac resynchronization therapy is an independent predictor of long-term mortality.},
  url          = {http://dx.doi.org/10.1093/europace/euu058},
  volume       = {16},
  year         = {2014},
}