Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

The benefits of cardiac resynchronisation therapy in heart failure

19.12.2011
Substantial improvements in symptoms and survival

However, large-scale clinical trials have highlighted the beneficial effect of cardiac resynchronisation therapy (CRT) in the improvement of symptoms and reduction of mortality, and CRT is now recommended in the major European and American guidelines for the treatment and prevention of heart failure.(1)

Clinical trials, however, are performed in carefully selected subjects and their results are not always applicable to the general population. Large-scale registries or surveys, on the other hand, capture data from a much more heterogeneous population and are closer to everyday clinical practice (although the applicability of the sample may be a concern).

Now, the European CRT Survey, whose follow-up results are published today in the European Journal of Heart Failure, suggests that CRT does indeed reduce rates of death and re-hospitalisation among heart failure patients.(2) Indeed, at one-year follow-up most patients who had received a CRT device considered their symptoms were better than their pre-implant assessment.(3)

The survey - a joint initiative of the Heart Failure Association and European Heart Rhythm Association of the European Society of Cardiology (ESC) - gathered information on more than 2000 patients at 141 centres in 13 European countries. Its aim was to assess the effect of CRT on symptom severity, cardiovascular re-hospitalisation, and survival. The study population included subjects poorly represented in clinical trials but commonly admitted as heart failure patients - including the very elderly, those with atrial fibrillation, and those previously treated with a pacemaker or other cardiac device.

Analysis of the survey data showed that at, one year (average) follow-up, 81% reported a self-assessed improvement in their symptoms (with 16% no change and 4% a deterioration).

The survey also found that almost 25% of the subjects had died or been re-hospitalised within the 12-month follow-up period. This poor outcome (whose rate is consistent with that found in clinical trials - was directly associated with the diagnostic severity of the heart failure, the pre-existence of atrial fibrillation (or other heart disease), and the type of resynchronisation cardiac device implanted. Patients implanted with a pacing device only (CRT-P) had higher rates of mortality than those whose device had an additional defibrillator (CRT-D).

First author Dr Nigussie Bogale from Stavanger University Hospital in Norway said: "This is the largest study reporting a difference in outcome between CRT-D and CRT-P. Most patients with an indication for CRT have also an indication for a defibrillator. So unless they have contraindicating co-morbidities, it is now our belief that these patients should be considered for CRT-D implantation."

The use of advanced CRT devices has gained increasing acceptance in recent years and they are now being implanted on a large scale as an adjunct to conventional drug treatment. Indeed, some reports have described the two types of devices (CRT-P and CRT-D) as a revolution in heart failure. One important study cited in the most recent guidelines on heart failure suggested implantation of an ICD was associated with a 23% reduction in all-cause mortality.(4)

One study reporting in 2009 found that throughout 15 European countries the number of CRT implantations increased substantially, from 46/million in 2004 to 99/million in 2008, an increase of 115%. This was mainly explained by an increase in use of CRT-D devices. One study cited by many recent guidelines (MADIT-CRT) found that CRT-D decreased the risk of heart-failure events even in relatively asymptomatic patients (with a 34% reduction in the risk of all-cause mortality or heart failure).(5) This European CRT Survey now suggests that benefits of this nature - in both symptoms and survival - can be replicated in routine everyday practice.

However, despite the benefits and the recommendations, other studies show there is still a wide gap between those who meet the criteria for CRT and those who actually have a device implanted.

Notes to editor

(1) Cardiac resynchronisation pacemakers (CRT-P) and defibrillators (CRT-D) for treating heart failure, which have evolved from conventional pacemakers, aim to correct abnormal contractions of the heart's ventricles. More than half of the mortality associated with heart failure is because of sudden cardiac death - and the most important predictor of SCD is left ventricular dysfunction, the underlying cause of heart failure. The use of CRT aims to correct dyssynchrony and prevent sudden cardiac death.

(2) Bogale N, Priori S, Cleland JGF, et al. The European CRT Survey: 1 year (9-15 months) follow-up results. Eur J Heart Fail 2011; doi:10.1093/eurjhf/hfr158.

(3) The main symptoms of heart failure are breathlessness (dyspnoea), tiredness and weakness, and oedema (swelling in the legs and ankles).

(4) Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009; 361: 1329-1338.

(5) Van Veldhuisen DJ, Maass AH, Priori SG, et al. Implementation of device therapy (cardiac resynchronization therapy and implantable cardioverter defibrillator) for patients with heart failure in Europe: changes from 2004 to 2008. Eur J Heart Fail 2009; doi:10.1093/eurjhf/hfp149.

* The European Journal of Heart Failure is a journal of the European Society of Cardiology.

* Heart failure is by far the single biggest reason for acute hospital admission. Around 30 million people in Europe have heart failure and its incidence is still increasing: more cases are being identified, more people are living to an old age, and more are surviving a heart attack but with damage to the heart muscle.

The 2010 Focused Update of ESC Guidelines on device therapy in heart failure can be seen in various formats

More information on this press release and a PDF of the paper is available from the ESC's press office press@escardio.org

ESC Press Office | EurekAlert!
Further information:
http://www.escardio.org

Further reports about: CRT CRT-D CRT-P ESC Heart atrial fibrillation cardiac death heart failure sudden cardiac death

More articles from Health and Medicine:

nachricht Organ-on-a-chip mimics heart's biomechanical properties
23.02.2017 | Vanderbilt University

nachricht Researchers identify cause of hereditary skeletal muscle disorder
22.02.2017 | Klinikum der Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Safe glide at total engine failure with ELA-inside

On January 15, 2009, Chesley B. Sullenberger was celebrated world-wide: after the two engines had failed due to bird strike, he and his flight crew succeeded after a glide flight with an Airbus A320 in ditching on the Hudson River. All 155 people on board were saved.

On January 15, 2009, Chesley B. Sullenberger was celebrated world-wide: after the two engines had failed due to bird strike, he and his flight crew succeeded...

Im Focus: Breakthrough with a chain of gold atoms

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

In the field of nanoscience, an international team of physicists with participants from Konstanz has achieved a breakthrough in understanding heat transport

Im Focus: DNA repair: a new letter in the cell alphabet

Results reveal how discoveries may be hidden in scientific “blind spots”

Cells need to repair damaged DNA in our genes to prevent the development of cancer and other diseases. Our cells therefore activate and send “repair-proteins”...

Im Focus: Dresdner scientists print tomorrow’s world

The Fraunhofer IWS Dresden and Technische Universität Dresden inaugurated their jointly operated Center for Additive Manufacturing Dresden (AMCD) with a festive ceremony on February 7, 2017. Scientists from various disciplines perform research on materials, additive manufacturing processes and innovative technologies, which build up components in a layer by layer process. This technology opens up new horizons for component design and combinations of functions. For example during fabrication, electrical conductors and sensors are already able to be additively manufactured into components. They provide information about stress conditions of a product during operation.

The 3D-printing technology, or additive manufacturing as it is often called, has long made the step out of scientific research laboratories into industrial...

Im Focus: Mimicking nature's cellular architectures via 3-D printing

Research offers new level of control over the structure of 3-D printed materials

Nature does amazing things with limited design materials. Grass, for example, can support its own weight, resist strong wind loads, and recover after being...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Booth and panel discussion – The Lindau Nobel Laureate Meetings at the AAAS 2017 Annual Meeting

13.02.2017 | Event News

Complex Loading versus Hidden Reserves

10.02.2017 | Event News

International Conference on Crystal Growth in Freiburg

09.02.2017 | Event News

 
Latest News

New pop-up strategy inspired by cuts, not folds

27.02.2017 | Materials Sciences

Sandia uses confined nanoparticles to improve hydrogen storage materials performance

27.02.2017 | Interdisciplinary Research

Decoding the genome's cryptic language

27.02.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>