title: Patient-assessed short-term positive response to cardiac resynchronization therapy is an independent predictor of long-term mortality.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) has a well-documented positive effect on mortality and heart failure morbidity. The aim of this study was to assess the long-term survival and the predictive value of self-assessed functional status on the long-term prognosis of patients treated with CRT-pacemaker (CRT-P).
  
  
  RESULTS
  Data were retrospectively collected from medical records of 446 consecutive patients implanted with CRT-P at a large-volume Swedish tertiary care centre. Primary outcome was all-cause mortality, predictive variables were assessed by log-rank test and univariate cox regression. Three hundred and nine patients had reliable information available on early improvement after implantation and were included in the multivariate analyses. The cohort was followed for a median of 79 months and was similar in baseline characteristics compared with major controlled trials. During follow-up 204 patients died, yearly mortality was 11.7%. Early improvement of self-assessed functional status was a strong independent predictor of survival [hazard ratio, HR 0.59, confidence interval (CI) 0.40-0.87, P = 0.007], together with well-known predictors; NYHA III-IV vs I-II (HR 1.66, CI 1.09-2.536, P = 0.018), age (HR 1.05, CI 1.03-1.08, P < 0.001), male gender (HR 2.0, CI 1.11-3.45, P = 0.021), and loop diuretic use (HR 4.41, CI 1.08-18.02). Patients with early improvement of self-assessed functional status had better 2-year and 5-year survival (P < 0.001).
  
  
  CONCLUSIONS
  Real-life patient characteristics and predictors of outcome compare well with those in published prospective trials. Self-assessed functional status is a strong predictor of long-term survival, which may have implications for a more active follow-up of patients without spontaneous improvement.
authors.affiliation: Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Reitan
authors.affiliation: Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Bakos
authors.affiliation: Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden.
authors.forename: Pyotr G
authors.initials: PG
authors.lastname: Platonov
authors.affiliation: Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden.
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Höijer
authors.affiliation: Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Brandt
authors.affiliation: Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden.
authors.forename: Lingwei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Cardiology, Arrhythmia Clinic, Lund University, Skane University Hospital, Getingevägen, Lund S-221 85, Sweden rasmus.borgquist@med.lu.se.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Borgquist
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D057566:Self Report; D012647:Self-Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013548:Sweden; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D049994:Sodium Potassium Chloride Symporter Inhibitors
keywords: CRT; Heart failure; Long-term follow-up; Prognostic factors