By Dr Jonathan Shurlock
Dr Baptiste Maille and co-authors have revisited the debate regarding the use of cardiac resynchronisation therapy – defibrillator (CRT-D) and – pacemaker (CRT-P).(1) The group used a nation-wide hospital discharge database to include all patients with CRT-D implantation in France between 2010 and 2019. The aim was to identify patients with a poor outcome within 1 year, in order to develop a risk or “futility” score. Data was collected for 23029 patients (Age 68±10 years (Mean ± Standard deviation)). 4873 participants were female (21%). The groups were divided into derivation and validation cohorts.
7016 deaths were recorded, with 1604 (22.8%) of those deaths occurring within 1 year of device implantation. The authors used a logistic regression model to identify and include a number of key predictors of futility in their risk score. The primary predictors included increasing age, history of heart failure related hospitalisation and comorbidities including diabetes, atrial fibrillation, renal and hepatic disease, malnutrition, anaemia and valvular heart disease (specifically aortic stenosis and mitral regurgitation).
The authors compared the performance of their CRT-D futility score to previously validated scores including the Goldernberg and EAARN scores and found an improved performance in identifying futility. Based on the CRT-D futility score 15.9% were determined to be high risk, with a predicted futility of 16.6%.
The group suggests that the score could be relevant when applied to individual decision making regarding CRT-D in order to shape best clinical practice.
See https://heart.bmj.com/content/heartjnl/early/2022/04/10/heartjnl-2021-320532.full.pdf for the full paper and link to the detailed components of the CRT-D futility score.
- Maille B, Bodin A, Bisson A, et al Predicting outcome after cardiac resynchronisation therapy defibrillator implantation: the CRT-D Futility scoreHeart Published Online First: 11 April 2022. doi: 10.1136/heartjnl-2021-320532 (edited)