Survival and Quality of Life in Patients With Cardiac Resynchronization Therapy for Severe Heart Failure and in Heart Transplant Recipients Within a Contemporary Heart Failure Management Program

Becker, Michael; Erdmann, Nora; Stegemann, Emilia; Benke, Dirk; Schauerte, Patrick N.; Schaefer, Wolfgang M.; Autschbach, Ruediger; Kelm, Malte; Koch, Karl-Christian

doi:10.1016/j.healun.2008.03.024

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 27, Issue 7 , Pages 746-752, July 2008

Survival and Quality of Life in Patients With Cardiac Resynchronization Therapy for Severe Heart Failure and in Heart Transplant Recipients Within a Contemporary Heart Failure Management Program

Michael Becker, MD
- Department of Cardiology, RWTH Aachen University, Germany
Nora Erdmann
- Department of Cardiology, RWTH Aachen University, Germany
Emilia Stegemann, MD
- Department of Cardiology, RWTH Aachen University, Germany
Dirk Benke, MD
- Department of Cardiology, RWTH Aachen University, Germany
Patrick N. Schauerte, MD
- Department of Cardiology, RWTH Aachen University, Germany
Wolfgang M. Schaefer, MD, PhD
- Department of Nuclear Medicine, RWTH Aachen University, Germany
Ruediger Autschbach, MD
- Department of Cardiac and Thoracic Surgery, RWTH Aachen University, Germany.
Malte Kelm, MD
- Department of Cardiology, RWTH Aachen University, Germany
Karl-Christian Koch, MD
- Department of Cardiology, RWTH Aachen University, Germany
- Reprint requests: Karl-Christian Koch, MD, Department of Cardiology, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany. Telephone: +49-241-80-80605. Fax: +49-241-80-82303.

Received 24 August 2007; received in revised form 5 January 2008; accepted 27 March 2008. published online 21 May 2008.

Background

Current treatment of advanced chronic heart failure comprises pharmacologic approaches, multidisciplinary management strategies and device therapy. We sought to compare the outcome after cardiac synchronization therapy (CRT) with the outcome after heart transplantation within a contemporary heart failure management program.

Methods

In a cohort study, survival and quality of life were assessed in 105 patients who had received CRT (53% with defibrillator) for severe heart failure and in 112 heart transplant recipients attending a heart failure clinic at a tertiary hospital. For assessment of health-related quality of life the Medical Outcome Short Form 36 (SF-36) was applied to the survivors. A propensity score for receiving transplantation vs CRT was developed using logistic regression and was incorporated into statistical models.

Results

Severity of heart failure before heart transplantation or CRT was similar. Survival was not different between device recipients and transplant recipients by Kaplan–Meier analysis. Cox regression analysis with time-dependent covariates revealed a significant interaction between treatment and time, which favored transplantation late after intervention. There were no significant differences in 7 of 8 subjective measures of health-related quality of life. The score for physical functioning was higher in the transplantation group; this difference remained of borderline significance after multivariate adjustment.

Conclusions

Contemporary management of patients with advanced heart failure including CRT leads to improved survival and quality of life and diminishes the difference in these outcomes between conservative management and heart transplantation within the time-frame studied. Patient selection for heart transplantation requires consideration of these results.