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).