BACKGROUND: Outcomes among inotrope-treated heart failure (HF) patients receiving cardiac resynchronization therapy (CRT) have not been well characterized, particularly in those requiring intravenous inotropes at the time of implant. METHODS: We analyzed 759 consecutive CRT-defibrillator recipients who were categorized as never on inotropes (NI; n = 585), weaned from inotropes before implant (PI; n = 124), or on inotropes at implant (II; n = 50). Survival free from heart transplant or ventricular assist device and overall survival were compared using the Social Security Death Index. A patient cohort who underwent unsuccessful CRT implantation and received a standard defibrillator (SD; n = 94) comprised a comparison group. Propensity score analysis was used to control for intergroup baseline differences. RESULTS: Compared with the other cohorts, II patients had more comorbidities. Both survival endpoints differed significantly (P < .001) among the 4 cohorts; II patients demonstrated shorter survival than NI patients, with the PI and SD groups having intermediate survival. After adjusting for propensity scores, overall differences and patterns in survival endpoints persisted (P < .01), but the only statistically significant pairwise difference was overall survival between the NI and II groups at 12 months (hazard ratio 2.95, 95% confidence interval 1.05-8.35). CRT recipients ever on inotropes (PI and II) and SD patients ever requiring inotropes (n = 17) experienced similar survival endpoints. Among II patients, predictors of hospital discharge free from inotropes after CRT included male gender, older age, and ability to tolerate β-blockade. CONCLUSIONS: Inotrope-dependent HF patients show significantly worse survival despite CRT than inotrope-naïve patients, in part because of more comorbid conditions at baseline. CRT may not provide a survival advantage over a standard defibrillator among patients who have received inotropes before CRT. Weaning from inotropes and initiating neurohormonal antagonists before CRT should be an important goal among inotrope-dependent HF patients.
BACKGROUND: Outcomes among inotrope-treated heart failure (HF) patients receiving cardiac resynchronization therapy (CRT) have not been well characterized, particularly in those requiring intravenous inotropes at the time of implant. METHODS: We analyzed 759 consecutive CRT-defibrillator recipients who were categorized as never on inotropes (NI; n = 585), weaned from inotropes before implant (PI; n = 124), or on inotropes at implant (II; n = 50). Survival free from heart transplant or ventricular assist device and overall survival were compared using the Social Security Death Index. A patient cohort who underwent unsuccessful CRT implantation and received a standard defibrillator (SD; n = 94) comprised a comparison group. Propensity score analysis was used to control for intergroup baseline differences. RESULTS: Compared with the other cohorts, II patients had more comorbidities. Both survival endpoints differed significantly (P < .001) among the 4 cohorts; II patients demonstrated shorter survival than NI patients, with the PI and SD groups having intermediate survival. After adjusting for propensity scores, overall differences and patterns in survival endpoints persisted (P < .01), but the only statistically significant pairwise difference was overall survival between the NI and II groups at 12 months (hazard ratio 2.95, 95% confidence interval 1.05-8.35). CRT recipients ever on inotropes (PI and II) and SD patients ever requiring inotropes (n = 17) experienced similar survival endpoints. Among II patients, predictors of hospital discharge free from inotropes after CRT included male gender, older age, and ability to tolerate β-blockade. CONCLUSIONS: Inotrope-dependent HF patients show significantly worse survival despite CRT than inotrope-naïve patients, in part because of more comorbid conditions at baseline. CRT may not provide a survival advantage over a standard defibrillator among patients who have received inotropes before CRT. Weaning from inotropes and initiating neurohormonal antagonists before CRT should be an important goal among inotrope-dependent HF patients.
Authors: E A Rose; A C Gelijns; A J Moskowitz; D F Heitjan; L W Stevenson; W Dembitsky; J W Long; D D Ascheim; A R Tierney; R G Levitan; J T Watson; P Meier; N S Ronan; P A Shapiro; R M Lazar; L W Miller; L Gupta; O H Frazier; P Desvigne-Nickens; M C Oz; V L Poirier Journal: N Engl J Med Date: 2001-11-15 Impact factor: 91.245
Authors: William T Abraham; Westby G Fisher; Andrew L Smith; David B Delurgio; Angel R Leon; Evan Loh; Dusan Z Kocovic; Milton Packer; Alfredo L Clavell; David L Hayes; Myrvin Ellestad; Robin J Trupp; Jackie Underwood; Faith Pickering; Cindy Truex; Peggy McAtee; John Messenger Journal: N Engl J Med Date: 2002-06-13 Impact factor: 91.245
Authors: Michael R Bristow; Leslie A Saxon; John Boehmer; Steven Krueger; David A Kass; Teresa De Marco; Peter Carson; Lorenzo DiCarlo; David DeMets; Bill G White; Dale W DeVries; Arthur M Feldman Journal: N Engl J Med Date: 2004-05-20 Impact factor: 91.245
Authors: Inder S Anand; Lloyd D Fisher; Yann-Tong Chiang; Roberto Latini; Serge Masson; Aldo P Maggioni; Robert D Glazer; Gianni Tognoni; Jay N Cohn Journal: Circulation Date: 2003-03-11 Impact factor: 29.690
Authors: Peter J Cowburn; Harshna Patel; Robynn E Jolliffe; Robert W Wald; John D Parker Journal: Eur J Heart Fail Date: 2005-03-02 Impact factor: 15.534
Authors: Steven L Higgins; John D Hummel; Imran K Niazi; Michael C Giudici; Seth J Worley; Leslie A Saxon; John P Boehmer; Michael B Higginbotham; Teresa De Marco; Elyse Foster; Patrick G Yong Journal: J Am Coll Cardiol Date: 2003-10-15 Impact factor: 24.094
Authors: James B Young; William T Abraham; Andrew L Smith; Angel R Leon; Randy Lieberman; Bruce Wilkoff; Robert C Canby; John S Schroeder; L Bing Liem; Shelley Hall; Kevin Wheelan Journal: JAMA Date: 2003-05-28 Impact factor: 56.272
Authors: Larry A Allen; Lynne W Stevenson; Kathleen L Grady; Nathan E Goldstein; Daniel D Matlock; Robert M Arnold; Nancy R Cook; G Michael Felker; Gary S Francis; Paul J Hauptman; Edward P Havranek; Harlan M Krumholz; Donna Mancini; Barbara Riegel; John A Spertus Journal: Circulation Date: 2012-03-05 Impact factor: 29.690