Does quality of life evidence assist in the selection of patients for resynchronization therapy?

Results from clinical trials of cardiac resynchronization therapy with biventricular pacemakers have demonstrated improvements in a variety of clinical parameters measured in patients over short-term follow-up. While not all approved medical therapies for heart failure improve quality of life, biventricular pacemakers offer a substantial opportunity for improving functional status and quality of life in patients with severe symptoms. This paper explores the evidence for routine measures of self-reported functional status and quality life as measures by which physicians might select individuals for resynchronization therapy. Data sources suggest approximately 50% of those individuals eligible for biventricular pacing have reduced quality of life at baseline, and hence, have considerable room for symptomatic improvement after implantation. Since baseline assessment of quality of life further predicts one-year mortality or hospitalization, it is likely that use of self reported quality of life, in addition to other factors as a guide for selection criteria, will result in improved event-free survival with biventricular pacing. In conclusion, assessment of quality of life before device implantation is necessary in order to select those individuals who are most likely to benefit from cardiac resynchronization therapy.