Giovanni B Forleo1, Luca Santini2, Leonardo Calò3, Danilo Ricciardi4, Antonio Curnis5, Carlo Pignalberi6, Vittorio Calzolari7, Massimo Giammaria8, Giovanni Morani9, Emanuele Bertaglia10, Valentina Ribatti11, Mauro Biffi12, Domenico Potenza13, Agostino Piro14, Gregorio Covino15, Veronica Natale1, Alessio Gasperetti1,11, Pasquale Notarstefano16, Carlo Lavalle14, Yelena Nabutovsky17, Claudio Tondo11, Francesco Zanon18. 1. Department of Cardiology, Azienda Ospedaliera-Universitaria "Luigi Sacco", Milano, Italy. 2. Division of Cardiology, Ospedale GB Grassi, Ostia, Italy. 3. Division of Cardiology, Policlinico Casilino, Roma, Italy. 4. Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Italy. 5. Department of Cardiology, Spedali Civili di Brescia, Brescia, Italy. 6. Department of Cardiology, Ospedale San Filippo Neri, Roma, Italy. 7. Division of Cardiology, Ospedale Cà Granda, Treviso, Italy. 8. Division of Cardiology, Ospedale Maria Vittoria, Torino, Italy. 9. Department of Cardiology, Azienda Ospedaliera Universitaria, Verona, Italy. 10. Department of Cardiology, Azienda Ospedaliera Universitaria, Padova, Italy. 11. Department of Cardiology, Centro Cardiologico Monzino, Milano, Italy. 12. Department of Cardiology, Policlinico S. Orsola-Maplighi, Bologna, Italy. 13. Division of Cardiology, Ospedale Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy. 14. Department of Cardiology, Policlinico Universitario Umberto I, Roma, Italy. 15. Division of Cardiology, Ospedale San Giovanni Bosco, Napoli, Italy. 16. Division of Cardiology, Ospedale San Donato, Arezzo, Italy. 17. Abbott, Santa Clara, California. 18. Division of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
Abstract
INTRODUCTION: Early evidence suggests that multipoint left ventricular pacing (MPP) may improve response to cardiac resynchronization therapy (CRT). It is unknown whether this benefit is sustained and cost-effective. We used real-world data to evaluate long-term impact of MPP-ON clinical status, heart failure hospitalizations (HFH) and costs. METHODS: The Italian registry on multipoint left ventricular pacing is a prospective, multicenter registry of patients implanted with MPP-enabled CRT devices. For this analysis, clinical and echocardiographic data were collected through 24 months and compared between patients with (MPP-ON) or without (MPP-OFF) early MPP activation at implant. The total cost of each HFH was estimated with national Italian reimbursement rates. RESULTS: The study included 190 MPP-OFF and 128 MPP-ON patients with similar baseline characteristics. At 1 and 2 years, the MPP-ON group had lower rates of HFH vs MPP-OFF (1-year hazard ratio [HR]: 0.14, P = .0014; 2-year HR: 0.38, P = .009). The finding persisted in a subgroup of patients with consistent MPP activation through follow-up (1-year HR: 0.19; P = .0061; 2-year HR: 0.39, P = .022). Total HFH per-patient costs were lower in the MPP-ON vs the MPP-OFF group at 1 year (€101 ± 50 vs €698 ± 195, P < .001) and 2 years (€366 ± 149 vs €801 ± 203, P = .038). More MPP-ON patients had ≥5% improvement in ejection fraction (76.8% vs 65.4%, P = .025) and clinical composite score (66.7% vs 47.5%, P = .01). CONCLUSIONS: In this multicenter clinical study, early MPP activation was associated with a significant reduction in cumulative HFH and related costs after 1 and 2 years of follow-up.
INTRODUCTION: Early evidence suggests that multipoint left ventricular pacing (MPP) may improve response to cardiac resynchronization therapy (CRT). It is unknown whether this benefit is sustained and cost-effective. We used real-world data to evaluate long-term impact of MPP-ON clinical status, heart failure hospitalizations (HFH) and costs. METHODS: The Italian registry on multipoint left ventricular pacing is a prospective, multicenter registry of patients implanted with MPP-enabled CRT devices. For this analysis, clinical and echocardiographic data were collected through 24 months and compared between patients with (MPP-ON) or without (MPP-OFF) early MPP activation at implant. The total cost of each HFH was estimated with national Italian reimbursement rates. RESULTS: The study included 190 MPP-OFF and 128 MPP-ON patients with similar baseline characteristics. At 1 and 2 years, the MPP-ON group had lower rates of HFH vs MPP-OFF (1-year hazard ratio [HR]: 0.14, P = .0014; 2-year HR: 0.38, P = .009). The finding persisted in a subgroup of patients with consistent MPP activation through follow-up (1-year HR: 0.19; P = .0061; 2-year HR: 0.39, P = .022). Total HFH per-patient costs were lower in the MPP-ON vs the MPP-OFF group at 1 year (€101 ± 50 vs €698 ± 195, P < .001) and 2 years (€366 ± 149 vs €801 ± 203, P = .038). More MPP-ON patients had ≥5% improvement in ejection fraction (76.8% vs 65.4%, P = .025) and clinical composite score (66.7% vs 47.5%, P = .01). CONCLUSIONS: In this multicenter clinical study, early MPP activation was associated with a significant reduction in cumulative HFH and related costs after 1 and 2 years of follow-up.