P5489Clinical effectiveness of cardiac ressincronization therapy in a cohort of patients with heart failure and chagas' disease

Abstract

Introduction: Cardiac resynchronization therapy (CRT) is known to be effective in reducing symptoms, hospitalization and mortality in patients with heart failure (HF), systolic dysfunction and ventricular dyssynchrony. The effectiveness of this therapy in clinical practice has not been well studied. The purpose of this study was to evaluate clinical effectiveness of both CRT pacemakers (CRT-P) and CRT with defibrillator (CRT-D), analyzing its beneficial impact on hospitalizations and overall patient survival. Objective(s): Evaluate the clinical effectiveness of CRT, analyzing the impact on hospitalizations and overall patient survival. Method(s): Prospective multicenter registry performed at 7 geographically distributed cardiology centers. Outcome measures were: New York Heart Association (NYHA) functional class (FC), mortality and hospitalization over 12-months of follow-up. Kaplan-Meier method was used for survival analysis and Coxregression model was used to identify predictors for mortality and hospitalization. Result(s): From January, 2014 to December, 2015, we enrolled 183 consecutive patients who underwent CRT device implantation for standard indications. Main baseline characteristics were: age = 60.7+/-14.1 years; male sex = 60.1%; left ventricular ejection fraction (LVEF) = 27.6+/-7.7%; NYHA FC III-IV = 59.1%; atrial fibrillation (AF) = 30.6%; Chagas disease = 13.7%; Ischemic cardiomyopathy= 20.8%; Nonischemic = 65.6%; CRT-P=83.6%; CRT-ICD = 16.4%. There was a significant improvement of the NYHA FC from the baseline to 12 months (FC III-IV 59.1% to 15.5%, P<0.001). Overall survival probability was 89.5% and 84.7% at 6 and 12-months, respectively. Chagas' Disease was an independent predictor of mortality (OR=8.6, 95% CI 3.1-24.0, P<0.001) when compared to the other cardiomyopathies. During follow-up, there were 39 (21.3%) hospitalizations, mostly due to decompensated HF. Chagas' disease (OR=3.4, 95% CI 1.3-9.0, P=0.016) and AF (OR=2.4, 95% CI 1.2-5.2, P=0.027) were independent predictors for hospitalization. Conclusion(s): Our results confirm that the clinical effectiveness of CRT in realworld clinical settings was similar with the results derived from recognized clinical trials. Chagas' Disease was the only predictor for mortality, increasing by 8.6 times the chance of death. In addition, Chagas' Disease and AF were predictors for hospitalization.