Effects of cardiac resynchronization therapy on long-term quality of life: An analysis from the CArdiac Resynchronisation-Heart Failure (CARE-HF) study
Received 12 February 2008; accepted 13 November 2008. published online 21 January 2009.
Background
Cardiac resynchronization therapy (CRT) improves quality of life (QoL) when measured 3 to 6 months after implantation, but whether these effects are sustained is unknown. The CArdiac Resynchronisation-Heart Failure study is the only long-term randomized trial of CRT with repeated measures of QoL.
Methods
Quality of life was measured at baseline and 3 months using generic European Quality of Life-5 Dimensions and disease-specific (Minnesota Living with Heart Failure) questionnaires and at 18 months and study-end using the latter instrument. Median follow-up was 29.6 (interquartile range 23.6-34.6) months.
Results
At baseline, patients had a substantially impaired QoL (mean European Quality of Life-5 Dimensions score 0.60, 95% confidence interval [CI] 0.58-0.62) compared to an age-matched general population (0.78, 95% CI 0.76-0.80). Quality of life improved to a greater extent in patients assigned to CRT at each time point (P < .0001). By 18 months, the mean difference in disease-specific QoL score was 10.7 (95% CI 7.6-13.8) in favor of CRT, mostly due to improved physical functioning. Differences were sustained thereafter. Quality-adjusted life-years at 18 months increased by 0.13 (95% CI 0.07-0.182) and by 0.23 (95% CI 0.13-0.33) at study-end (both P < .0001). Little heterogeneity of effect across subgroups was observed.
Conclusion
Cardiac resynchronization therapy improves long-term QoL and survival in patients with moderate to severe heart failure. The effects appear sustained, and therefore, the gain in quality-adjusted life years with CRT should be even greater during longer term follow-up.
aDepartment of Cardiology, University of Hull, Castle Hill Hospital, Kingston upon Hull, United Kingdom
bDepartment of Primary Care and General Practice, University of Birmingham, Birmingham, United Kingdom
cMedtronic Inc., Bakken Research Centre, Maastricht, The Netherlands
Reprint requests: John G. F. Cleland, Department of Cardiology, University of Hull HU16 5JQ, Castle Hill Hospital, Kingston upon Hull, United Kingdom.
ABSTRACT