Abstract 19925: Predictors of Quality-of-Life Benefit After Cardiac Resynchronization Therapy
Background: While clinical trials have clearly established the average benefit of cardiac resynchronization therapy (CRT), estimating the benefits for an individual patient remains difficult due to the heterogeneity of treatment response. To better inform patient selection for CRT, based upon effects on quality of life (QoL), we created a multivariable risk prediction model of benefit in QoL at 3 months after CRT implantation.
Methods: Patient-level data from 5 randomized controlled trials comparing CRT with control groups were used to create prediction models of QoL response based on the Minnesota living with Heart Failure questionnaire (MLHFQ). A partial proportional odds model for the categories of worse QoL, no change, small, moderate, large improvement were created. The c-statistics for each threshold were calculated.
Results: Of 3716 patients available for analysis most were in NYHA class II (49%) or III (45%). Across the 5 studies, the mean difference in MLHFQ scores was 3.5 points (-13.7 with CRT vs. -10.2 without; p < 0.001), which is below the estimated minimally important difference of -6.7 points. This mean difference masked considerable heterogeneity of QoL benefit (figure 1). A partial proportional odds model identified age, baseline QoL and an interaction of CRT with QRS duration as predictors of improvement in 3-month QoL with CRT, with c-statistics for different thresholds of change of 0.71 - 0.79.
Conclusions: There is substantial patient-level variability in the QoL benefits from CRT. Prediction models may help support patient selection and shared medical decision-making to optimize the safety, outcomes, and cost-effectiveness of CRT.
Figure 1. Individual patient’s baseline (X axis), and 3 month (Y axis) Minnesota Living With Heart Failure overall score after being assigned to receive cardiac resynchronization therapy.
Author Disclosures: M. Nassif: None. W.T. Abraham: Consultant/Advisory Board; Significant; Novartis, St. Jude Medical, Biotronik, Medtronic. J.G. Cleland: Other Research Support; Modest; biotronik. Other Research Support; Significant; Amgen. Consultant/Advisory Board; Modest; Amgen, St. Jude Medical. P.G. Jones: None. D. Schaber: Employment; Significant; Medtronic. L. Sherfesee: Employment; Significant; Medtronic. Y. Tang: None. J.B. Young: Consultant/Advisory Board; Modest; Medtronic. J.A. Spertus: None.
- © 2016 by American Heart Association, Inc.