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Cardiac resynchronisation is a mechanical treatment for severe heart failure that uses biventricular pacing to improve the function of the left ventricleventricle.. About one fifth of patients attending heart failure clinics are eligible for the treatment, which improves symptoms, prolongs survival, and helps prevent hospital admission, according to a thorough and systematic review of the evidence.
Compared with best medical treatment alone, additional cardiac resynchronisation reduced all cause mortality by 22% (13.2% v 15.5%, relative risk 0.78, 95% CI 0.67 to 0.91) and hospital admission by 37% (19% v 27%, 0.63, 0.43 to 0.93). In 14 randomised trials, cardiac resynchronisation also improved patients' quality of life.
The survival benefits looked similar in a further 95 observational studies. A review of safety data showed that 4.3% of patients had periprocedural complications (0.3% died). Between 6% and 7% of devices broke down in the first year.
Cardiac resynchronisation looked consistently good value for money across all recent economic evaluations, costing no more than $20000 (£10150, €15000) for each quality adjusted life year saved.
The authors conclude that this technology works for patients who still have severe symptoms, low ejection fraction, and ventricular dys-synchrony—identified by long duration of the QRS complex—despite the best available medical treatment.