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CRT in Mild-HF patients: the experts’ debate

 
Nearly 5000 mildly symptomatic patients have been enrolled in randomised controlled trials to date with the aim of understanding the impact of CRT therapy on morbidity and mortality in class NYHAI-II patients.
The recent evidence resulted from Reverse and MADIT-CRT trials confirms that CRT reduces the risk of death or heart failure event in mildly symptomatic patients asserting the benefits of CRT in this population.

In this article Prof. Cecilia Linde, main investigator of the Reverse trial, and Prof. John G. Cleland, main investigator of the CARE-HF trial, have been interviewed over the hottest questions on this topic.
1. Both trials demonstrated reverse remodelling, manifested as improvement of LVEF and LVESVi. Is CRT actually reversing the course of HF?
2. Are there mortality benefits from CRT in Mild-HF patients?
3. Are results from MADIT-CRT and REVERSE likely to change guidelines for CRT towards a greater use in Mild-HF patients?
4. Should physicians reduce their focus on the sickest patients and increase efforts on implanting the therapy in mild patients?
5. Is there sufficient evidence that the use of CRT in mild HF patients is a cost effective use of limited healthcare budgets?
Professor Linde presented the cost effectiveness analysis of the European patients in the REVERSE study, as referred to in the video, at the annual meeting of the French Society of Cardiology in January 2010.

The incremental cost per Quality Adjusted Life Year (QALY) gained is €14,278, which is below widely accepted thresholds of willingness to pay in health care. Thus, CRT is cost-effective for patients in the REVERSE study.