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Capstone

Cardiac-Resynchronization in Moderate Heart Failure

1 December 2010

Abstract

Background: Heart failure affects millions of elderly and is a major cause for hospitalization and death. A large percentage of these patients will present with a prolonged QRS interval. This lag between the firing of the right and left ventricles can make the heart inefficient, causing poor perfusion. Patients with a prolonged QRS generally do not respond well to the current pharmacological treatments available and continue to have worsening symptoms and progression of their disease. Cardiac resynchronization therapy attempts to stimulate both ventricles simultaneously, with an implantable device, and thereby increasing the heart’s output.

Method: An exhaustive search of available medical literature was performed using PubMed, Web of Science, Cochrane, the National Clinical Trials Registry and CINHAL databases looking for studies on mortality and morbidity of cardiac resynchronization therapy compared to pharmacological therapy. Using the key words ‘Heart Failure’, ‘Cardiac Resynchronization’, ‘Moderate’, ‘Mortality’ and ‘Death’, individually and in combination. The search was limited to human subjects, full text availability, the English language and articles from 2000 to 2010.

Results: The search revealed three randomized controlled trials with an extension of one of the three trials. All the studies found a significant decrease of mortality and morbidity with the use of cardiac synchronization therapy. Every one of the three also noted a higher rate of adverse events, secondary to implantation, associated with this therapy.

Conclusion: By performing a systematic review using GRADE to evaluate the quality of evidence, it was determined that cardiac-resynchronization therapy appreciably decreased the rate of death and hospitalizations over optimal pharmacological care and should be considered for patients with a prolonged QRS associated with heart failure.


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