Authors' objectives: In the following report we review literature on CRT efficacy, safety and cost-effectiveness to identify subgroups of heart failure patients in whom CRT will result in the greatest benefit in order to support optimal use of this high-cost procedure. We also report the trends in use of CRT over the last 5 years and the budget impact at the MUHC. A separate report has been prepared on CRT in heart block patients.

Authors' recommendations: There is sufficient evidence to support the use of CRT for patients with NYHA Class II/III, severely prolonged QRS interval (>150 msec); LBBB morphology, and LVEF <30%. The effect of CRT is less certain in patients with NYHA Class IV-ambulatory, moderate QRS interval (120-150 msec), non-LBBB morphology, and LVEF >30%. Though some guidelines and HTAs have recommended CRT use in these subgroups, their recommendations appear to be based on the entry criteria and not the actual characteristics of patients enrolled in the RCTs. (It should be noted that unlike clinical guideline documents our report does not provide guidance on how individual patients should be treated. Rather our focus has been to distinguish between those situations where there is good evidence to support the use of CRT and where there is not. The decision to treat an individual patient is left to the discretion of the treating physician.) QRS duration >150 msec is the strongest predictor of CRT response. QRS morphology i.e. the presence of LBBB may also be a potential indicator of good response to CRT. The use and budget impact of CRT-P and CRT-D at the MUHC has been increasing over the years. Since 2015 the MUHC has adopted a new funding model under which the cost of these devices is now covered within the global Cardiology budget. At the MUHC, there is currently no systematic documentation of patient selection criteria or evaluation of patient outcomes following CRT.

Project Status: Completed

Year Published: 2016

URL for published report: http://www.mcgill.ca/tau/files/tau/muhc_tau_2016_77_biv_heart_failure.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 boul. de Maisonneuve, Bureau 3F.50, Montreal, Quebec H4A 3S5

Contact Name: nandini.dendukuri@mcgill.ca

Contact Email: nandini.dendukuri@mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)