P447Reduction of 30-day hospital readmissions with device-based CRT optimization in patients with a Non-LBBB IVCD or a QRS

Abstract

Background: Policies designed to reduce hospital readmission rates among heart failure patients have been instituted globally to advance quality outcomes at a lower cost. RESPOND-CRT is a multicenter, randomized trial, assessing a number of clinical outcomes based upon cardiac resynchronization therapy (CRT) optimization programming, by comparing SonR device-driven optimization processes to those directed by echocardiography-based (ECHO) CRT optimization processes. This sub-study compared hospital discharge and readmission rates between SonR and Echo among a group of patients who are known to be less responders to CRT. Objective: This sub-study investigated the impact of repetitive, weekly optimization of AV and VV delays using SonR optimization methods compared to ECHO optimization on the all-cause hospitalization and 30-day hospital readmission rates among patients with a Non-LBBB IVCD or a QRS<150ms. Methods: The all-cause hospitalization rates and the 30-day all-cause hospital readmission rates were collected for all patients. Standard statistical methods were used to compare those rates between the SonR and ECHO CRT optimization groups. Results: A total of 396/998 patients (39.7% of the total RESPOND-CRT patients) met the QRS/morphology enrollment criteria defined for the sub group. The QRS was narrow in 276 (69.7%), ≥150 msec in 112 (28.3%) or unknown in 8 (2.0%) of pts. The mean age was 66.8±10.3. Of these, 95% were in NYHA class III and the mean LVEF was 30.1±8.6%. This population accounted for 54.2% of the all-cause 30-day readmissions & 51.3% of the all-cause hospitalizations. Among pts discharged from the hospital the readmission rate per discharge was 1.08 in SonR and 1.19 in ECHO (OD=0.43, 95%CI: [0.11-1.71], p=NS). Following CRT optimization, the all-cause 30- day readmission rate per patient was 0.14 in SonR and 0.26 in ECHO (OD=0.54, 95%CI: [0.34-0.87], p=0.0106). Conclusions: 1) CRT optimization with SonR is associated with a significant reduction in the all-cause 30-day hospital readmission rate compared to ECHO optimization in patients with narrow QRS or a Non-LBBB IVCD or a QRS<150ms. 2) Additional information about the heart failure re-hospitalization rates & longer follow-up data are needed to define the full benefit. (Figure Presented).