Premium
Prognostic Impact of Implementation of QRS Characteristics in the Seattle Heart Failure Model in ICD and CRT‐D Recipients
Author(s) -
VAN DER HEIJDEN AAFKE C.,
LEVY WAYNE C.,
VAN ERVEN LIESELOT,
SCHALIJ MARTIN J.,
BORLEFFS C. JAN WILLEM
Publication year - 2016
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12862
Subject(s) - medicine , qrs complex , hazard ratio , cardiology , cardiac resynchronization therapy , proportional hazards model , heart failure , confidence interval , bundle branch block , left bundle branch block , survival analysis , electrocardiography , ejection fraction
Background The Seattle Heart Failure Model (SHFM) provides accurate estimates of survival in heart failure (HF) patients. The model is, however, not developed for HF patients with cardiac resynchronization therapy (CRT). The aim of this study was to assess the prognostic value of SHFM combined with QRS morphology and CRT‐related change in QRS duration in implantable cardioverter defibrillator (ICD) and CRT defibrillator (CRT‐D) recipients. Methods All patients who underwent prophylactic ICD implantation at the Leiden University Medical Center since 1996 were included. Baseline SHFM, QRS morphology, and duration before and after device implantation were determined. The regression coefficients of the QRS characteristics derived from a Cox regression analysis were implemented in the SHFM. SHFM‐estimated survival was compared with Kaplan‐Meier observed survival. Results The current study includes 1,834 defibrillator recipients (63 ± 11 years; 79% male; 53% CRT‐D). In 585 (60%) CRT‐D recipients a left bundle branch block was present, the mean QRS duration was 147 ± 31 ms before and 151 ± 27 ms after device implantation. After a median follow‐up of 4.4 years (25 th –75 th percentile 2.7–6.4 years), 285 (29%) CRT‐D recipients had died. CRT‐related decrease in QRS duration adjusted for QRS morphology was associated with improved survival (hazard ratio 1.05/10 ms; 95% confidence interval [CI]: 1.01–1.09; P = 0.02). The estimated 5‐year survival of CRT‐D recipients after implementation of the QRS characteristic was 70%, and comparable with the observed 5‐year survival of 68% (95% CI: 65–72). Conclusion Implementation of native QRS morphology and change in QRS duration due to CRT in the SHFM improves the prognostic value of this model in HF patients with CRT‐D.