Abstract 1893: Is Early Symptomatic Improvement Associated with Long-term Benefit with Cardiac Resynchronization? Insights from the COMPANION Study
Introduction: Cardiac resynchronization therapy (CRT) has been associated with a response rate of 65–70%, typically based on symptoms or exercise. However, relatively little attention has been focused on the association between early improvement and long-term benefit using survival or hospitalization as an outcome.
Methods: The COMPANION database was analyzed retrospectively one-month post-randomization. Patients (pts) were classified as “Improved” if NYHA Class and/or Global Assessment (GA) improved, “Worsened” for heart failure hospitalization (HFH) or worsening of either NYHA Class or GA. Patients who were neither “Improved” or “Worsened” were classified as “Unchanged”. Using the one-month visit as baseline, pts were followed for all-cause mortality (ACM) or HFH for each of the three cohorts and event rates compared between the three arms.
Results: A total of 1212 pts were randomized to CRT. At the one-month visit, 793 (65%) had Improved, 299 (25%) were Unchanged, and 92 (8%) Worsened. The remaining 28 pts (2%) died prior to or had not reached one-month of follow-up. The figure⇓ below illustrates the Kaplan-Meier curves and hazard ratios for each of the pairwise comparisons.
Conclusions: The prognosis of pts randomized to CRT who had “Improved” symptomatically at one month was similar to those in whom symptoms were “Unchanged” compared to baseline. The prognosis of these two groups was superior to that of pts who “Worsened”. This outcome suggests that pts whose symptoms remain stable over a one month period derive a mortality and hospitalization benefit from CRT similar to that of pts whose symptoms improved. Further study is needed to confirm this retrospective analysis.