Optimizing heart failure treatment following cardiac resynchronization therapy

Jorsal, A., Pryds, K., McMurray, J. J.V. , Wiggers, H., Sommer, A., Nielsen, J. C. and Nielsen, R. R. (2020) Optimizing heart failure treatment following cardiac resynchronization therapy. Clinical Research in Cardiology, 109(5), pp. 638-645. (doi: 10.1007/s00392-019-01553-4) (PMID:31559483)

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Device therapy in addition to medical treatment improves prognosis in a subset of patients with heart failure and reduced ejection fraction. However, some patients remain symptomatic or their heart failure even progresses despite cardiac resynchronization therapy (CRT). The aim of the study was to evaluate the proportion of patients who could benefit from optimization of medical therapy using sacubitril/valsartan, ivabradine, or both following CRT implantation. We conducted a post hoc analysis of a single-centre, patient and outcome-assessor blinded, randomized-controlled trial, in which patients scheduled for CRT were randomized to empiric (n = 93) or imaging-guided left-ventricular lead placement (n = 89). All patients underwent clinical evaluation and blood sampling at baseline and 6 months following CRT implantation. The proportion of patients meeting the indication for sacubitril/valsartan (irrespective of angiotensin-converting enzyme inhibitor or angiotensin 2 receptor blocker dosage) and/or ivabradine according to current guidelines was evaluated at baseline and after 6 months. Of 182 patients with an indication for CRT, 146 (80%) also had an indication for optimization of medical therapy at baseline by adding sacubitril/valsartan, ivabradine, or both. Of the 179 survivors at 6 months, 136 (76%) were still symptomatic after device implantation; of these, 51 (38%) patients had an indication for optimization of medical therapy: sacubitril/valsartan in 37 (27%), ivabradine in 7 (5%), and both drugs in 7 (5%) patients. Seven (18%) patients without indication at baseline developed an indication for medical optimization 6 months after CRT implantation. In the present study, 38% of those who remained symptomatic 6 months after CRT implantation were eligible for optimization of medical therapy with sacubitril/valsartan, ivabradine, or both. Patients with CRT may benefit from systematic follow-up including evaluation of medical treatment.

Item Type:Articles
Additional Information:Funding: The ImagingCRT study was funded by Aarhus University, the Danish Heart Foundation (11-04-R84-A3234-22641), the Danish Council for Independent Research (11-107461), Central Denmark Region (1-45-72-4-09), Eva and Henry Frænkels Foundation, and Fabrikant Karl G. Andersens Foundation.
Glasgow Author(s) Enlighten ID:McMurray, Professor John
Authors: Jorsal, A., Pryds, K., McMurray, J. J.V., Wiggers, H., Sommer, A., Nielsen, J. C., and Nielsen, R. R.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Clinical Research in Cardiology
ISSN (Online):1861-0692
Published Online:26 September 2019

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