Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Suarthana E, Almeida N, Dendukuri N.. Cardiac resynchronization therapy in heart failure. Montreal: Technology Assessment Unit of the McGill University Health Centre (MUHC). 2016 Authors' objectives In the following report we review literature on CRT efficacy, safety and cost-effectiveness to identify subgroups of heart failure patients in whom CRT will result in the greatest benefit in order to support optimal use of this high-cost procedure. We also report the trends in use of CRT over the last 5 years and the budget impact at the MUHC. A separate report has been prepared on CRT in heart block patients. Authors' conclusions There is sufficient evidence to support the use of CRT for patients with NYHA Class II/III, severely prolonged QRS interval (>150 msec); LBBB morphology, and LVEF <30%.
The effect of CRT is less certain in patients with NYHA Class IV-ambulatory, moderate QRS interval (120-150 msec), non-LBBB morphology, and LVEF >30%. Though some guidelines and HTAs have recommended CRT use in these subgroups, their recommendations appear to be based on the entry criteria and not the actual characteristics of patients enrolled in the RCTs. (It should be noted that unlike clinical guideline documents our report does not provide guidance on how individual patients should be treated. Rather our focus has been to distinguish between those situations where there is good evidence to support the use of CRT and where there is not. The decision to treat an individual patient is left to the discretion of the treating physician.)
QRS duration >150 msec is the strongest predictor of CRT response. QRS morphology i.e. the presence of LBBB may also be a potential indicator of good response to CRT.
The use and budget impact of CRT-P and CRT-D at the MUHC has been increasing over the years. Since 2015 the MUHC has adopted a new funding model under which the cost of these devices is now covered within the global Cardiology budget.
At the MUHC, there is currently no systematic documentation of patient selection criteria or evaluation of patient outcomes following CRT. Indexing Status Subject indexing assigned by CRD MeSH Cardiac Resynchronization Therapy; Heart Failure; Humans Language Published English Country of organisation Canada English summary An English language summary is available. Address for correspondence Technology Assessment Unit of the MUHC, Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 boul. de Maisonneuve, Bureau 3F.50, Montreal, Quebec H4A 3S5 Email: nandini.dendukuri@mcgill.ca AccessionNumber 32017000419 Date abstract record published 06/11/2017 |