Clinical InvestigationsOutcomes, Health Policy, and Managed CareEffects of cardiac resynchronization therapy on long-term quality of life: An analysis from the CArdiac Resynchronisation-Heart Failure (CARE-HF) study
Section snippets
Methods
The design and main results of the CARE-HF study have been reported.8, 12, 14, 15 Briefly, patients in sinus rhythm, with moderate to severe chronic heart failure despite conventional pharmacologic therapy, with a left ventricular ejection fraction (LVEF) of <35%, a left ventricle end-diastolic dimension of ≥30 mm (indexed to height), and a QRS interval of >120 milliseconds were enrolled. Patients with a QRS interval of 120 to 149 milliseconds had to meet additional echocardiographic criteria
Results
Patient characteristics at baseline are shown in Table I. Univariate analyses of the relationship between baseline EQ-5D score revealed associations between worse EQ-5D score and being a woman, having worse NYHA class, more mitral regurgitation or higher amino-terminal brain natriuretic peptide, and with use of β-blockers or higher doses of loop diuretics. A forward regression approach was used to generate a final model, in which worse baseline EQ-5D score was associated with female sex, worse
Discussion
This analysis of the CARE-HF study confirms that, in patients with moderate or severe heart failure and markers of dyssynchrony, the addition of CRT to pharmacologic therapy improves symptoms and QoL in the short-term and shows that these effects persist for several years, resulting in an increase in QALY. The effect on the MLWHFQ score in CARE-HF was relatively large (10.6). Quality of life has been measured in only a few randomized trials of treatments now accepted as effective in guidelines
Conclusions
Early gains in health-related quality-of-life with CRT are sustained for ≥2 years, which, combined with increased longevity results in an increase in QALYs. Benefits were observed in most subgroups without convincing heterogeneity of effect.
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