Predictors of Quality-of-Life Benefit After Cardiac Resynchronization Therapy

Background: While clinical trials have clearly established the average benefit of cardiac resynchronization therapy (CRT), estimating the benefits for an individual patient remains difficult due to the heterogeneity of treatment response. To better inform patient selection for CRT, based upon effects on quality of life (QoL), we created a multivariable risk prediction model of benefit in QoL at 3 months after CRT implantation. Methods: Patient-level data from 5 randomized controlled trials comparing CRT with control groups were used to create prediction models of QoL response based on the Minnesota living with Heart Failure questionnaire (MLHFQ). A partial proportional odds model for the categories of worse QoL, no change, small, moderate, large improvement were created. The c-statistics for each threshold were calculated. Results: Of 3716 patients available for analysis most were in NYHA class II (49%) or III (45%). Across the 5 studies, the mean difference in MLHFQ scores was 3.5 points (-13.7 with CRT ...