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Heart Failure Management

Heart Failure Management

Cardiac resynchronization therapy is a proven treatment for selected heart failure patients with a wide QRS. When used in combination with optimal medical therapy, cardiac resynchronization therapy improves symptoms and extends survival.1-5

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Clinical Issue

Clinical Issue – Poor Prognosis for Heart Failure Patients with a Wide QRS

Heart failure – related morbidity and mortality remains a major problem6-9

  • Heart failure patients with a wide QRS have poor prognoses6-9
  • Heart failure accounts for over 3.4 million visits to physician offices, hospital outpatient, and emergency departments annually6
  • Heart failure hospitalizations are especially problematic, with one year readmission rates of 50% and mortality rates of approximately 30% 7,8
  • In patients with heart failure, sudden death occurs at four times the rate of the general population9

QRS duration and Left Ventricular Ejection Fraction: Predictors of morbidity and mortality

  • Wide QRS duration is a powerful independent predictor of poor clinical outcomes in patients with HF and reduced left ventricular ejection fraction (LVEF)10
  • QRS durations ≥ 120 ms are associated with a 33% increased risk of all-cause mortality (38% from worsening HF and 31% from sudden death)11
  • Clinical studies show that a low EF is a key predictor of sudden cardiac arrest and an effective way to determine a patient's risk for sudden cardiac arrest (SCA).9,12,13



Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. April 15, 2005;352(15)1539-1549.


Cleland JG, Daubert JC, Erdmann E, et al. Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE-HF) trial extension phase]. Eur Heart J. August 2006;27(16):1928-1932.


Bristow MR, Feldman AM, Saxon LA. Heart failure management using implantable devices for ventricular resynchronization: Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure (COMPANION) trial. COMPANION Steering Committee and COMPANION Clinical Investigators. J Card Fail. September 2000;6(3):276-285.


Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. June 13, 2002;346(24):1845-1853.


Young JB, Abraham WT, Smith AL, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA. May 28, 2003;289(20):2685-2694.


Burt CW, Schappert SM. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 1999-2000. Vital Health Stat 13. September 2004;(157):1-70.


Kosiborod M, Lichtman JH, Heidenreich PA, et al. National trends in outcomes among elderly patients with heart failure. Am J Med. July 2006;119(7):616.e1-7.


Rathore SS, Masoudi FA, Wang Y, et al. Socioeconomic status, treatment, and outcomes among elderly patients hospitalized with heart failure: findings from the National Heart Failure Project. Am Heart J. August 2006;152(2):371-378.


Adabag AS, Therneau TM, Gersh BJ, Weston SA, Roger VL. Sudden death after myocardial infarction. JAMA. 2002;300(17):2022-2029.


Hawkins NM, Wang D, McMurray JJ, et al. Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme. Eur J Heart Fail. 2007;9(5):510-517.


Wang NC, Maggioni AP, Konstam MA, et al. Clinical implications of QRS duration in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction. JAMA. 2008;299(22):2656-2666.


Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-1463.


Priori SG, Aliot E, Blomstrom-Lundqvist C, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology [published correction appears in Eur Heart J. 2002;23:257]. Eur Heart J. August 2001;22(16):1374-1450.

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