Cardiac resynchronization therapy in acute heart failure and left bundle-branch block in a real-life registry
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Objective:
To determine the prevalence, characteristics, timing of implementation and prognosis of patients with left bundle branch block (LBBB) and acute heart failure (AHF) treated with cardiac resynchronization therapy (CRT) in a real-life registry.
Methods:
We analysed the characteristics of patients with AHF and LBBB at the time of inclusion in the EAHFE (Epidemiology Acute Heart Failure Emergency) cohort to determine the indication for CRT, the timing of implementation and its impact on 10-year all-cause mortality.
Results:
729 patients with a median age of 82 years and there was a high burden of comorbidities and functional dependence. The median left-ventricle ejection fraction (LVEF) was 40%. Forty-six (6%) patients were treated with CRT at some point during follow-up, with a median time of delay for CRT implementation of 960 (IQR=1147 days) and at least 108 more untreated patients fulfilled criteria for CRT. Patients receiving CRT were younger, had different comorbidities, less functional dependence (higher Barthel index) and lower LVEF values. The median follow-up was 5.7 years (95% CI: 5.6-5.8) and CRT was not associated with changes in 10-year mortality (adjusted HR 1.33, 95% CI: 0.72-2.48; p-value 0.4). When compared with untreated patients fulfilling criteria for CRT, very similar results were observed (adjusted HR 1.34, 95% CI: 0.67-2.68).
Conclusions:
CRT implementation was delayed and underused in patients with AHF and LBBB. Under these circumstances, CRT is not associated with a reduction in all-cause mortality in the long term.
- Heart failure
- bundle-branch block
- cardiac resynchronization therapy
- Stroke Volume
- Pacemaker, Artificial
- Real world data
Oriol Aguilo Pedret, 1 Hospital d'Olot i Comarcal de la Garrotxa
https://orcid.org/0000-0001-8695-8508
Joan Carles Trullàs, Tissue Repair and Regeneration Laboratory (TR2Lab), Institut de Recerca i Innovació en Ciències de la Vida i de la Salut a la Catalunya Central (IrisCC), Girona, Catalonia, Spain. - Hospital d'Olot i Comarcal de La Garrotxa, Internal Medicine Department, Girona, Catalonia, Spain. - Hospital General de Alicante, Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Alicante, Spain, Hospital General de Alicante, Hospital General de Alicante, Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Alicante , Spain.
https://orcid.org/0000-0002-7380-3475
Begoña Espinosa, Hospital General de Alicante, Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Alicante, Spain, Hospital General de Alicante, Hospital General de Alicante, Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Alicante , Spain. - Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain. - Universidad Miguel Hernández, Alicante, Spain.
https://orcid.org/0000-0001-9531-6451
Pedro López-Ayala, University Hospital of Basel
https://orcid.org/0000-0002-7787-0640
Victor Gil, University of Barcelona, Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain.
https://orcid.org/0000-0003-3757-0579
María Luisa López-Grima, Hospital Doctor Peset
https://orcid.org/0000-0002-5484-5071
Pablo Herrera-Puente, Hospital Universitario Central de Asturias, Emergency Department, Oviedo, Spain
https://orcid.org/0000-0002-5529-5008
Javier Jacob, Hospital Universitari de Bellvitge, Emergency Department, Barcelona, Catalonia, Spain. , Hospitalet de Llobregat, Barcelona, Catalonia, Spain
https://orcid.org/0000-0003-1101-1066
Maria del Pilar López-Díez, Hospital Universitario de Burgos, Emergency Department, Burgos, Spain
https://orcid.org/0000-0003-3562-5804
José Manuel Garrido, Hospital Virgen de Valme, Emergency Department, Sevilla, Spain.
https://orcid.org/0000-0002-5440-4882
Javier Millán, Hospital Politécnico La Fe, Emergency Department, Valencia, Spain.
https://orcid.org/0000-0003-3499-9089
Alfonso Aguirre, Hospital del Mar, Emergency Department, Barcelona, Catalonia, Spain.
https://orcid.org/0000-0002-2569-3611
Pascual Piñera, Hospital Universitario Reina Sofía, Emergency Department, Murcia, Spain.
https://orcid.org/0000-0001-9213-9357
Christian E. Müller, University Hospital of Basel, Cardiology Department, Basel, Switzerland. - Cardiovascular Research Institute Basel, Basel, Switzerland. - The GREAT network, Rome, Italy
https://orcid.org/0000-0002-1120-6405
Pere Llorens, Hospital General de Alicante, Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Alicante, Spain, Hospital General de Alicante, Hospital General de Alicante, Emergency Department, Short Stay Unit and Hospitalization at Home Unit, Alicante , Spain. - Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain. - Universidad Miguel Hernández, Alicante, Spain.
https://orcid.org/0000-0002-9291-7179
Òscar Miro, The GREAT network, Rome, Italy. - University of Barcelona, Emergency Department, Hospital Clínic, IDIBAPS, Barcelona, Catalonia, Spain.
https://orcid.org/0000-0001-8127-166X
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Accepted 2024-04-29
Published 2024-10-03
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