October 4, 2017
Clinical Cardiology has published an article titled, “Exploration of the Association between Ischemic Etiology and the Likelihood of Heart Failure Hospitalization Following Cardiac Resynchronization Therapy.”
The study’s lead author, Adam C. Powell, Ph.D., and his team sought to evaluate whether recipients of cardiac resynchronization therapy (CRT-D) with ischemic heart disease respond differently to the treatment than do recipients with heart disease due to other causes. They investigated this as it is possible that myocardial scarring resulting from ischemia (insufficient blood supply to the heart muscle because of coronary artery disease) may interfere with effective lead placement during the implantation of defibrillators. Extensive scarring is known to be associated with poorer physiological and survival outcomes in patients who undergo CRT-D.
Patients who underwent CRT-D between February 1, 2013, and February 1, 2014, were identified in an insurer’s claims. Inclusion required one year of enrollment pre- and post-CRT-D. The sample was divided into nonischemic and ischemic groups, and a subset of the ischemic group with a history of ST elevation myocardial infarction (STEMI) was identified. The likelihood of heart failure (HF) hospital admission in the year pre- and post-CRT-D was computed for each group, as well as for the subset of patients with HF admissions prior to CRT-D.
A significant (P=.02) association was found between ischemic etiology and the post-CRT-D HF admission likelihood. There was no association found between a history of STEMI versus nonischemic status and the likelihood of post-CRT-D HF admission. All groups studied had significantly lower risk of HF admissions after CRT-D. None of the comparisons involving only patients with a HF hospitalization in the year prior to CRT-D were significant. The study concluded that patients with nonischemic etiology were significantly less likely to experience a HF admission after CRT-D, but the risk of HF admission improved significantly in all groups after CRT-D.
According to Dr. Powell, “This study was a joint effort between HealthHelp and Humana. Our organizations have amassed a substantial amount of patient data which can be used to develop new clinical insights. In this particular study, we were able to learn from the experiences of 1,303 patients located across the country and to share our findings with the medical community. Findings from real-world outcomes research can be helpful to patients and physicians making tough decisions.”