Response to cardiac resynchronization therapy: is it time to expand the criteria?
BACKGROUND
Cardiac resynchronization therapy (CRT) is a promising treatment for a subgroup of patients with advanced congestive heart failure and a prolonged QRS interval. Despite the majority of patients benefiting from CRT, 10-40% of patients do not respond to this treatment and are labeled as nonresponders. Given that there is a lack of consensus on how to define response to CRT, the purpose of this viewpoint is to discuss currently used definitions and their shortcomings, and to provide recommendations as to how an expansion of the criteria for CRT response may be useful to clinicians.


RESULTS
Analysis of the literature and case reports indicates that the majority of established measures of CRT response, including New York Heart Association functional class and echocardiographic, hemodynamic, and neurohormonal parameters, are poor associates of patient-reported symptoms and quality of life. Moreover, the potential moderating role of psychological factors in determining health outcomes after CRT has largely been neglected.


CONCLUSIONS
It is recommended to routinely assess health status after CRT with a disease-specific questionnaire in standard clinical practice and to examine its determinants, including psychological factors such as personality traits and depression. This may lead to improved (secondary) treatment and prognosis in CHF patients treated with CRT.
Versteeg
Henneke
H
CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical Psychology, Tilburg University, The Netherlands.
Schiffer
Angélique A
AA
Widdershoven
Jos W
JW
Meine
Mathias M
MM
Doevendans
Pieter A
PA
Pedersen
Susanne S
SS
D002304:Cardiac Pacing, Artificial / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D016896:Treatment Outcome