Abstract 16286: Cardiac Resynchronization Therapy in Non-Ambulatory Class IV Heart Failure.

Introduction: Non-ambulatory class IV heart failure (HF) patients have not been evaluated in trials of cardiac resynchronization therapy (CRT). There is limited data on the management of class IV HF patients in clinical practice, including CRT eligibility, clinical course, and treatment with advanced HF therapies (left ventricular assist device or transplant). Hypothesis: There are a substantial number of patients with ambulatory and non-ambulatory NYHA Class IV HF who do not have CRT and would be potential candidates for CRT placement. Methods: Patients at a single, academic medical center, referred to the advanced HF clinic or admitted to the hospital for initiation of inotropes from 1/1/08 to 12/31/13 were identified. Manual chart review was completed in order to obtain data on patients' comorbidities and cardiovascular testing. Baseline characteristics of the outpatient and inpatient populations were compared using chi square analyses or T-tests. Descriptive analyses of the two populations were performed, including CRT eligibility; treatment with CRT, left ventricular assist device, and transplant; and mortality. Results: Among 395 patients, 206 were inotrope inpatients and 189 were outpatients. Sixty patients from the inotrope and 62 from the outpatient cohorts were CRT eligible: a predominance of RV pacing (13.3% and 22.5%), presence of a BiV device with inadequate pacing (30% and 19.3%), Class I indications (25.3% and 9.6%), and Class II indications (29.6% and 11.2%), respectively. In the inotropic group 26 patients did not receive LVAD or OHT, compared to 40 patients in the ambulatory group, with only a small proportion of eligible patients receiving CRT (Figure). Conclusions: The majority of patients evaluated for advanced HF therapies met criteria for CRT placement and either died or received LVAD/OHT without CRT implantation. CRT could prove beneficial in those patients who are not LVAD or transplant candidates despite optimal medical management. [ABSTRACT FROM AUTHOR]