Cardiac-Resynchronization in Moderate Heart Failure

Background: Heart failure affects millions of elderly and is a major cause for hospitalization and death. A large percentage of these patients will present with a prolonged QRS interval. This lag between the firing of the right and left ventricles can make the heart inefficient, causing poor perfusion. Patients with a prolonged QRS generally do not respond well to the current pharmacological treatments available and continue to have worsening symptoms and progression of their disease. Cardiac resynchronization therapy attempts to stimulate both ventricles simultaneously, with an implantable device, and thereby increasing the heart’s output. Method: An exhaustive search of available medical literature was performed using PubMed, Web of Science, Cochrane, the National Clinical Trials Registry and CINHAL databases looking for studies on mortality and morbidity of cardiac resynchronization therapy compared to pharmacological therapy. Using the key words ‘Heart Failure’, ‘Cardiac Resynchronization’, ‘Moderate’, ‘Mortality’ and ‘Death’, individually and in combination. The search was limited to human subjects, full text availability, the English language and articles from 2000 to 2010. Results: The search revealed three randomized controlled trials with an extension of one of the three trials. All the studies found a significant decrease of mortality and morbidity with the use of cardiac synchronization therapy. Every one of the three also noted a higher rate of adverse events, secondary to implantation, associated with this therapy. Conclusion: By performing a systematic review using GRADE to evaluate the quality of evidence, it was determined that cardiac-resynchronization therapy appreciably decreased the rate of death and hospitalizations over optimal pharmacological care and should be considered for patients with a prolonged QRS associated with heart failure. Degree Type Capstone Project Rights Terms of use for work posted in CommonKnowledge. This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/247 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). You may download or print any portion of this document for personal use only, or for any use that is allowed by fair use (Title 17, §107 U.S.C.). Except for personal or fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, or distribute this document, or any portion thereof, without the permission of the copyright owner. [Note: If this document is licensed under a Creative Commons license (see “Rights” on the previous page) which allows broader usage rights, your use is governed by the terms of that license. ] Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights, Pacific University Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiries may be directed to:. copyright@pacificu.edu This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/247 NOTICE TO READERS This work is not a peer-reviewed publication. The Master’s Candidate author of this work has made every effort to provide accurate information and to rely on authoritative sources in the completion of this work. However, neither the author nor the faculty advisor(s) warrants the completeness, accuracy or usefulness of the information provided in this work. This work should not be considered authoritative or comprehensive in and of itself and the author and advisor(s) disclaim all responsibility for the results obtained from use of the information contained in this work. Knowledge and practice change constantly, and readers are advised to confirm the information found in this work with other more current and/or comprehensive sources. The student author attests that this work is completely his/her original authorship and that no material in this work has been plagiarized, fabricated or incorrectly attributed. Cardiac-Resynchronization A course paper presented to the College of Health Professions in partial fulfillment of the requirements of the degree of Pacific University School of Physician Assistant Studies Faculty Advisor: Clinical Graduate Project Instructors: Torry Cobb, DHSc, MPH, PA Annjanette Sommers MS, PA in Moderate Heart Failure Christopher W. Hughes