title: Survival and quality of life in patients with cardiac resynchronization therapy for severe heart failure and in heart transplant recipients within a contemporary heart failure management program.
abstract: BACKGROUND
  Current treatment of advanced chronic heart failure comprises pharmacologic approaches, multidisciplinary management strategies and device therapy. We sought to compare the outcome after cardiac synchronization therapy (CRT) with the outcome after heart transplantation within a contemporary heart failure management program.
  
  
  METHODS
  In a cohort study, survival and quality of life were assessed in 105 patients who had received CRT (53% with defibrillator) for severe heart failure and in 112 heart transplant recipients attending a heart failure clinic at a tertiary hospital. For assessment of health-related quality of life the Medical Outcome Short Form 36 (SF-36) was applied to the survivors. A propensity score for receiving transplantation vs CRT was developed using logistic regression and was incorporated into statistical models.
  
  
  RESULTS
  Severity of heart failure before heart transplantation or CRT was similar. Survival was not different between device recipients and transplant recipients by Kaplan-Meier analysis. Cox regression analysis with time-dependent covariates revealed a significant interaction between treatment and time, which favored transplantation late after intervention. There were no significant differences in 7 of 8 subjective measures of health-related quality of life. The score for physical functioning was higher in the transplantation group; this difference remained of borderline significance after multivariate adjustment.
  
  
  CONCLUSIONS
  Contemporary management of patients with advanced heart failure including CRT leads to improved survival and quality of life and diminishes the difference in these outcomes between conservative management and heart transplantation within the time-frame studied. Patient selection for heart transplantation requires consideration of these results.
authors.affiliation: Department of Cardiology, RWTH Aachen University, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.forename: Nora
authors.initials: N
authors.lastname: Erdmann
authors.forename: Emilia
authors.initials: E
authors.lastname: Stegemann
authors.forename: Dirk
authors.initials: D
authors.lastname: Benke
authors.forename: Patrick N
authors.initials: PN
authors.lastname: Schauerte
authors.forename: Wolfgang M
authors.initials: WM
authors.lastname: Schaefer
authors.forename: Ruediger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.forename: Karl-Christian
authors.initials: KC
authors.lastname: Koch
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011788:Quality of Life; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome