Effects of cardiac resynchronization therapy on long-term quality of life: An analysis from the CArdiac Resynchronisation-Heart Failure (CARE-HF) study

被引:78
作者
Cleland, Joltn G. F. [1 ]
Calvert, Melanie J. [2 ]
Verboven, Yves [3 ]
Freemantle, Nick [2 ]
机构
[1] Univ Hull, Dept Cardiol, Castle Hill Hosp, Kingston Upon Hull HU16 5JG, Yorks, England
[2] Univ Birmingham, Dept Primary Care & Gen Practice, Birmingham, W Midlands, England
[3] Medtronic Inc, Baker Res Ctr, Maastricht, Netherlands
基金
英国医学研究理事会;
关键词
UNITED-KINGDOM; TRIAL; MORTALITY; EQ-5D; DYSFUNCTION; POPULATION; VALUATIONS; MANAGEMENT; MORBIDITY; PLACEBO;
D O I
10.1016/j.ahj.2008.11.006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Cardiac resynchronization therapy (CRT) improves quality of life (QoL) when measured 3 to 6 months after implantation, but whether these effects are sustained is unknown. The CArdiac Resynchronisation-Heart Failure study is the only long-term randomized trial of CRT with repeated measures of QoL. Methods Quality of life was measured at baseline and 3 months using generic European Quality of Life-5 Dimensions and disease-specific (Minnesota Living with Heart Failure) questionnaires and at 18 months and study-end using the latter instrument. Median follow-up was 29,6 (interquartile range 23.6-34.6) months. Results At baseline, patients had a substantially impaired QoL (mean European Quality of Life-5 Dimensions score 0.60, 95% confidence interval [CI] 0.58-0.62) compared to an age-matched general population (0.78, 95% CI 0.76-0.80). Quality of life improved to a greater extent in patients assigned to CRT at each time point (P < .0001). By 18 months, the mean difference in disease-specific QoL score was 10.7 (95% CI 7.6-13.8) in favor of CRT, mostly due to improved physical functioning. Differences were sustained thereafter. Quality-adjusted life-years at 18 months increased by 0.13 (95% CI 0.07-0.182) and by 0.23 (95% CI 0.13-0.33) at study-end (both P < .0001). Little heterogeneity of effect across subgroups was observed. Conclusion Cardiac resynchronization therapy improves long-term QoL and survival in patients with moderate to severe heart failure. The effects appear sustained, and therefore, the gain in quality-adjusted life years with CRT should be even greater during longer term follow-up. (Am Heart J 2009; 157:457-66.)
引用
收藏
页码:457 / 466
页数:10
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