Patients with heart failure who are "nonresponders" to cardiac resynchronization therapy (CRT) are often "passively managed, without specialty care, with poor outcome," according to results of the ADVANCE CRT study published Nov. 11 in the Journal of the American College of Cardiology, which will be presented during AHA 2019 in Philadelphia, PA.

Niraj Varma, MD, PhD, et al., looked at 1,524 heart failure patients enrolled in 69 centers in the ADVANCE CRT Registry. Patients were ages 68 ±12 years, 32 percent were female, and 39 percent had ischemic disease. Further, 74.3 percent received CRT-D devices. Researchers assessed patient response at six months post-implant using site-specific definitions, compared to a Clinical Composite Score (CCS).

Results showed that out of 1,327 patients, 20.0 percent were nonresponders. In addition, researchers found that site-specific definitions used mainly clinical criteria, and underestimated nonresponders by 35 percent vs. CCS (58 percent sensitivity vs. CCS). Further, more site-defined nonresponders (55.9 percent) received treatment using medication changes and heart failure education, but received device programming less frequently vs. responders (38.3 percent, p<0.001). The researchers also found that 44 percent of site-defined nonresponders received no additional treatment.

The authors conclude that "nonresponders require rigorous attention to accurate diagnosis (which may be facilitated by an objective assessment such as CCS), follow-up intensification and integration with cross-disciplinary care, and exploration of effective interventions." They add that their study "reveals an unmet need in a high-risk heart failure population."

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, Statins, Acute Heart Failure

Keywords: AHA Annual Scientific Sessions, AHA19, Cardiac Resynchronization Therapy, Follow-Up Studies, Heart Failure, Maleimides, Cyclic N-Oxides, Registries

< Back to Listings