Precision medicine for cardiac resynchronization: predicting quality of life benefits for individual patients-an analysis from 5 clinical trials

Nassif, M. E. et al. (2017) Precision medicine for cardiac resynchronization: predicting quality of life benefits for individual patients-an analysis from 5 clinical trials. Circulation: Heart Failure, 10(10), e004111. (doi:10.1161/CIRCHEARTFAILURE.117.004111) (PMID:29038172)

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Abstract

Background: Clinical trials have established the average benefit of cardiac resynchronization therapy (CRT), but estimating benefit for individual patients remains difficult because of the heterogeneity in treatment response. Accordingly, we created a multivariable model to predict changes in quality of life (QoL) with and without CRT. Methods and Results: Patient-level data from 5 randomized trials comparing CRT with no CRT were used to create a prediction model of change in QoL at 3 months using a partial proportional odds model for no change, small, moderate, and large improvement, or deterioration of any magnitude. The C statistics for not worsening or obtaining at least a small, moderate, and large improvement were calculated. Among the 3614 patients, regardless of assigned treatment, 33.3% had a deterioration in QoL, 9.2% had no change, 9.2% had a small improvement, 13.5% had a moderate improvement, and the remaining 34.9% had a large improvement. Patients undergoing CRT were less likely to have a decrement in their QoL (28.2% versus 38.9%; P<0.001) and more likely to have a large QoL improvement (38.7% versus 30.6%; P<0.001). A partial proportional odds model identified baseline QoL, age, and an interaction of CRT with QRS duration as predictors of QoL benefits 3 months after randomization. C statistics of 0.65 for not worsening, 0.68 for at least a small improvement, 0.69 for at least a moderate improvement, and 0.73 for predicting a large improvement were observed. Conclusions: There is marked heterogeneity of treatment benefit of CRT that can be predicted based on baseline QoL, age, and QRS duration.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Nassif, M. E., Tang, Y., Cleland, J. G.F., Abraham, W. T., Linde, C., Gold, M. R., Young, J. B., Daubert, J. C., Sherfesee, L., Schaber, D., Tang, A. S.L., Jones, P. G., Arnold, S. V., and Spertus, J. A.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Circulation: Heart Failure
Publisher:American Heart Association
ISSN:1941-3289
ISSN (Online):1941-3297
Published Online:16 October 2017
Copyright Holders:Copyright © 2017 American Heart Association, Inc.
First Published:First published in Circulation: Heart Failure 10(10): e004111
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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