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The results of a cardiac resynchronization program in a district hospital
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Bruno Castilho
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Bruno Miranda Castilho; Ana Rita Veiga; Ana Rita Moura; Mariana Saraiva; Nuno Craveiro; Kevin Domingues; Ana Filipa Damásio; Vitor Martins
Abstract
<p><u><span style="font-size:18px"><span style="font-family:"Calibri Light",sans-serif">The results of a cardiac resynchronization program in a district hospital</span></span></u></p> <p> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Cardiac resynchronization therapy (CRT) devices are a cornerstone in contemporary heart failure (HF) treatment, improving morbidity and mortality outcomes in patients with symptomatic reduced ejection fraction (<35%) and wide QRS complexes. The aim of this work is to evaluate the results of a CRT program in a district hospital. Since the definition of CRT response is widely variable according to different studies, we used three <em>major</em> categories of CRT response to evaluate our patients: Clinical (improvement in NYHA class); Assessment of reverse remodeling (improvement of left ventricular ejection fraction, proportion of super-responders, decrease of QRS duration); Outcomes assessment ( HF hospitalizations and mortality). </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective study based on the analysis of patients who implanted a CRT device between January 2014 and December 2019 in a district hospital. </span></span><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">We defined non-responders as patients whose LVEF decreased after 12 months of CRT therapy and super-responders as patients whose LVEF increased over 10%. The following endpoints were evaluated after 12 months of CRT therapy: Improvement in New York Heart Association (NYHA) functional class, proportion of super-responders, responders and non-responders, variation in LVEF and QRS duration, death from cardiovascular causes and hospital admissions due to HF.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>RESULTS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During this period 88 patients implanted CRT devices, with the following baseline characteristics: mean age of <span style="font-size:10.0pt">70.9±9.6 </span>years old; male predominance (<span style="font-size:10.0pt">70.5</span>%); 37,5% patients with ischemic cardiomyopathy. After 12 months of CRT device implantation there was a significant recovery in LVEF (mean LVEF before CRT was 27.2±6.4 and after 12 months was 38±10.7 , p<<em>0,01), </em> with 40% super-responders and only 9.6% non-responders. We observed a NYHA class improvement after 12 months in 74.7% of our patients. QRS complex duration decreased significantly from 168±21.3ms to 148.4±20ms (p<0,01). Cardiovascular mortality after 12 months was 6.8% and only 17.6% of our patients had one or more hospital admissions due to HF.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSIONS</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This study results confirm the benefits of introducing a program of cardiac resynchronization therapy in a district hospital (in trend with the robust scientific evidence that support the benefits of CRT therapy). Such results might encourage district hospitals to start CRT programs in order to enhance the treatment of HF.</span></span></p>
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