Сhanges in quality of life in patients with congestive heart failure after cardiac resynchronization therapy

Purpose. To assess the quality of life (QoL) changes in patients with congestive heart failure (CHF) one year after cardiac resynchronization therapy (CRT). Methods. The study included 82 patients (68 males and 14 females) aged from 30 to 74 (mean age 55.8±9.2 years) who underwent implantation of a biventricular cardiac pacemaker for CRT. Depending on the echocardiographic response to CPT, the patients were divided into two groups: 56 people with a positive response (responders) and 26 people with insufficient response (non-responders). The SF-36 questionnaire was used to measure QoL. The results of the questionnaire were represented as scores over the eight subscales: physical functioning (PF), role-physical functioning (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health perceptions (MH). The QoL assessment was performed before and one year after CRT. Results. Patients with CHF one year following CRT had significantly higher rates of improvement in PF QoL (before CRT 46.28±26.16; one year after CRT 53.05±27.65, p=0.023). The statistical tendency towards QoL improvement was revealed: VT QoL (before CRT 47.07±20.12, after CRT 51.83±20.07, p=0.081), SF (before СРТ 61.58±25.06, after CRT 67.07±24.57, p=0.088). Group of responders one year after CRT had significantly higher rates of improvement of QoL in PF (45.2±26.0 before CRT vs 57.1±26.4 after CRT, p=0.001); in VT (46.5±20.8 vs 54.4±19.7, p=0.010) and in SF (60.9±26.4 vs 70.8±20.8, p=0.012). The statistical tendency towards QoL improvement was revealed in BP (57.5±25.1 before CRT vs 64.8±23.8 after CRT, p=0.079), in GH (45.3±16.4 vs 49.1±18.0, p=0.079) and in MH (57.7±18.9 vs 62.5±17.7, p=0.081). In the group of nonresponders the statistical tendency towards decrease in QoL was detected during one year after CRT in RE (46.2±45.3 before CRT vs 26.9±41.1 after CRT, p=0.07). No significant differences were found in paired comparisons of other QoL indicators. Conclusion. We revealed significant increase in PF index in patients with CHF one year following CRT. The study showed that QoL was generally improving one year following CRT in responders while a tendency towards decrease in RE was detected in non-responders.

1. What quality of life? The WHOQOL Group. World Health Organization Quality of Life Assessment. World Health Forum. 1996;17(4):354–6. PMID: 9060228

2. Dempster M, Donnelly M. A Comparative Analysis of the SF-12 and the SF-36 among Ischaemic Heart Disease Patients. Journal of Health Psychology. 2001;6(6):707–11. DOI: 10.1177/135910530100600608

3. Schweikert B, Hunger M, Meisinger C, Konig H-H, Gapp O, Holle R. Quality of life several years after myocardial infarction: comparing the MONICA/KORA registry to the general population. European Heart Journal. 2008;30(4):436–43. DOI: 10.1093/eurheartj/ehn509

4. Dickens CM, McGowan L, Percival C, Tomenson B, Cotter L, Heagerty A et al. Contribution of depression and anxiety to im paired health-related quality of life following first myocardial infarction. British Journal of Psychiatry. 2006;189(4):367–72. DOI: 10.1192/bjp.bp.105.018234

5. Carvalho MV de, Siqueira LB, Sousa ALL, Jardim PCBV. The Influence of Hypertension on Quality of Life. Arquivos Brasileiros de Cardiologia. 2013;100(2):164–74. DOI: 10.5935/abc.20130030

6. Trevisol DJ, Moreira LB, Fuchs FD, Fuchs SC. Health-related quality of life and awareness of hypertension: Journal of Hypertension. 2012;30(3):629. DOI: 10.1097/HJH.0b013e32834f9bbf

7. Hobbs FDR, Kenkre JE, Roalfe AK, Davis RC, Hare R, Davies MK. Impact of heart failure and left ventricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population. European Heart Journal. 2002;23(23):1867–76. DOI: 10.1053/euhj.2002.3255

8. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128

9. Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.A., Garganeeva A.A. et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8–164. DOI: 10.18087/cardio.2475

10. Mareev V.Yu., Ageev F.T., Arutyunov G.P., Koroteev A.V., Mareev Yu.V., Ovchinnikov A.G. et al. SEHF, RSC and RSMSIM national guidelines on CHF diagnostics and treatment (fourth revision) Approved at the SEHF Congress on December 7, 2012, at the SEHF Board of Directors meeting on March 31, 2013, and at the RSC Congress on September 25, 2013. Russian Heart Failure Journal. 2013;14(7):379–472. DOI: 10.18087/rhfj.2013.7.1860

11. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: The Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). European Heart Journal. 2013;34(29):2281–329. DOI: 10.1093/eurheartj/eht150

12. Nagy KV, Széplaki G, Perge P, Boros AM, Kosztin A, Apor A et al. Quality of life measured with EuroQol-five dimensions questionnaire predicts long-term mortality, response, and reverse remodelling in cardiac resynchronization therapy patients. EP Europace. 2018;20(9):1506–12. DOI: 10.1093/europace/eux342

13. Lenarczyk R, Jędrzejczyk-Patej E, Mazurek M, Szulik M, Kowalski O, Pruszkowska P et al. Quality of Life in Cardiac Resynchronization Recipients: Association with Response and Impact on Outcome. Pacing and Clinical Electrophysiology. 2015;38(1):8–17. DOI: 10.1111/pace.12523

14. Knackstedt C, Arndt M, Mischke K, Marx N, Nieman F, Kunert HJ et al. Depression, psychological distress, and quality of life in patients with cardioverter defibrillator with or without cardiac resynchronization therapy. Heart and Vessels. 2014;29(3):364–74. DOI: 10.1007/s00380-013-0372-8

15. Chung ES, Leon AR, Tavazzi L, Sun J-P, Nihoyannopoulos P, Merlino J et al. Results of the Predictors of Response to CRT (PROSPECT) Trial. Circulation. 2008;117(20):2608–16. DOI: 10.1161/CIRCULATIONAHA.107.743120

16. Novik A.A., Ionova T.I. Guide to the study of quality of life in medicine. – M.: OLMA Media Grupp;2007. - 313 p. ISBN 978-5-373-01011-5

17. Ivchenko G.I., Medvedev Yu.I. Mathematical statistics. – M.: Librokom;2014. – 352 p. ISBN 978-5-397-04141-6

18. Costanzo MR. Cardiac Resynchronization Therapy in Women. Cardiac Electrophysiology Clinics. 2015;7(4):721–34. DOI: 10.1016/j.ccep.2015.08.018

19. Biton Y, Zareba W, Goldenberg I, Klein H, McNitt S, Polonsky B et al. Sex Differences in Long-Term Outcomes with Cardiac Resynchronization Therapy in Mild Heart Failure Patients With Left Bundle Branch Block. Journal of the American Heart Association. 2015;4(7):e002013. DOI: 10.1161/JAHA.115.002013

20. Zusterzeel R, Spatz ES, Curtis JP, Sanders WE, Selzman KA, Piña IL et al. Cardiac resynchronization therapy in women versus men: observational comparative effectiveness study from the National Cardiovascular Data Registry. Circulation. Cardiovascular Quality and Outcomes. 2015;8(2 Suppl 1):S4-11. DOI: 10.1161/CIRCOUTCOMES.114.001548

21. Enina T.N., Kuznetsov V.A., Soldatova A.M., Petelina T.I., Krinochkin D.V., Rychkov A.Yu. et al. Biochemical aspects of gender differences in response to cardiac resynchronization therapy. Russian Heart Journal. 2017;16(2):103–9. DOI: 10.18087/rhj.2017.2.2323

22. Nassif ME, Tang Y, Cleland JG, Abraham WT, Linde C, Gold MR et al. Precision Medicine for Cardiac Resynchronization: Predicting Quality of Life Benefits for Individual Patients – an Analysis from 5 Clinical Trials. Circulation: Heart Failure. 2017;10(10):e004111. DOI: 10.1161/CIRCHEARTFAILURE.117.004111

23. De Marco T, Wolfel E, Feldman AM, Lowes B, Higginbotham MB, Ghali JK et al. Impact of Cardiac Resynchronization Therapy on Exercise Performance, Functional Capacity, and Quality of Life in Systolic Heart Failure with QRS Prolongation: COMPANION Trial Sub-Study. Journal of Cardiac Failure. 2008;14(1):9–18. DOI: 10.1016/j.cardfail.2007.08.003

24. Chen S, Yin Y, Krucoff MW. Effect of cardiac resynchronization therapy and implantable cardioverter defibrillator on quality of life in patients with heart failure: a meta-analysis. Europace. 2012;14(11):1602–7. DOI: 10.1093/europace/eus168

25. Ypenburg C, van Bommel RJ, Borleffs CJW, Bleeker GB, Boersma E, Schalij MJ et al. Long-Term Prognosis After Cardiac Resynchronization Therapy Is Related to the Extent of Left Ventricular Reverse Remodeling at Midterm Follow-Up. Journal of the American College of Cardiology. 2009;53(6):483–90. DOI: 10.1016/j.jacc.2008.10.032