Long-term Effect of Cardiac Resynchronisation in Patients reporting Mild Symptoms of Heart Failure: A Report from the CARE-HF Study

John GF Cleland ^1*, Nick Freemantle ², Jean-Claude Daubert ³, William Toff ⁴, Franz Leisch ⁵ and Luigi Tavazzi ⁶

¹ University of Hull, United Kingdom
² University of Birmingham, United Kingdom
³ Hopital Pontchaillou, Rennes, France
⁴ University Hospitals of Leicester NHS Trust, United Kingdom
⁵ Academic Hospital, Linz, Austria
⁶ IRCCS Policlinico S.Matteo, Italy

^* To whom correspondence should be addressed. E-mail: j.g.cleland{at}hull.ac.uk.

Accepted 9 October 2007

Abstract

Background Cardiac resynchronisation therapy (CRT) improves symptoms and prognosis in patients with heart failure and cardiac dyssynchrony. Guidelines from the National Institute of Clinical Excellence in the United Kingdom recommend CRT for patients with moderate or severe symptoms that either recent or persistent. We investigated whether the severity of symptoms was an important determinant of the prognostic benefits of CRT.

Methods Data from the CARE-HF trial, which randomly assigned 813 patients with left ventricular ejection fraction ,,T35% and markers of cardiac dyssynchrony who were in the investigators opinion in New York Heart Association (NYHA) class III/IV, to pharmacological treatment alone or with the addition of CRT, were analysed to determine whether the severity of symptoms reported by patients influenced prognosis and the response to CRT. Symptoms of heart failure were assessed using Likert Scales from the EuroHeart Failure Questionnaire, which also records patients i: self-assessed NYHA class.

Results Patients assessed themselves to be in NYHA class I or II in 175 cases (21.5%). These patients also reported less severe symptoms and better quality of life than patients who assessed themselves to be in NYHA class III or IV. No statistical interaction was observed between the severity of symptoms assessed in a number of different ways and the benefits of CRT on morbidity and mortality.

Conclusions The severity of symptoms was not an important determinant of the prognostic effects of CRT in patients with moderate or severe LVSD and markers of dyssynchrony in the CARE-HF study. This finding requires confirmation in an adequately powered prospective randomized controlled trial in patients with milder symptoms.

Keywords: Chronic heart failure, mild symptoms, resychronisation

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