This is an interesting discovery - people can have heart failure without symptoms!
This, of course, flies in the face of most of the definitions of heart failure. Take, for instance, this definition from Mayo Clinic:
"Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's needs."How is someone supposed to know that the blood flow needs from the heart are not met if the patient has no signs or symptoms? Saying it another way, does this mean that everyone with left bundle branch block and no symptoms might actually have heart failure?
The lines of classifying the severity of heart failure have never been clear, despite what our medical coders and researchers would like us to believe.
In reality, in the upstream push to prevent heart failure, MADIT-CRT (the study the FDA cited to reach its approval of Boston Scientific's CRT and CRT-D devices) has demonstrated that intervening BEFORE symptoms occur in patients with weak heart muscles and left bundle branch block can improve mortality and reduce hospitalizations for heart failure. This a good thing.
But what we also have learned is that patient symptoms are immaterial for device implantation any longer in patients with weak heart muscles (EF <= 30%) and left bundle branch block (with QRS width of 130 msec or more) on their EKG. As such, classic symptoms of "heart failure" like shortness of breath, swollen legs, and the like, are also immaterial to qualify for a cardiac resynchronization device.
This makes me wonder if we should still be calling CRT devices "heart failure" devices or rather, "heart preserving" devices.
For now, they'll have to stay "heart failure" devices, despite all of the negative connotations. For whoa to the doctor that forgets to give the diagnosis of at least "Congestive heart failure, NYHA Class I" (or, "congestive heart failure without symptoms") when they ask, pretty please, for permission to implant one of these devices from our insurers in our new era of cardiovascular
Such are the billing and coding games we must continue to play.
Reference: The NEJM publication of MADIT-CRT.