Long-Term Results of Cardiac Resynchronization Therapy: A Comparison between CRT-Pacemakers versus Primary
Christian Reitan1, Uzma Chaudhry1, Zoltan Bakos1
1Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden.
Insights
Cardiac resynchronization therapy defibrillators (CRT-D) did not improve long-term survival compared to CRT pacemakers (CRT-P) in real-world heart failure patients. Patient selection is key for CRT-D benefit.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) improves outcomes in heart failure.
- Comparisons between CRT defibrillators (CRT-D) and CRT pacemakers (CRT-P) are limited outside clinical trials.
- This study assesses CRT patient characteristics and compares CRT-D versus CRT-P effectiveness.
Purpose of the Study:
- To evaluate baseline characteristics influencing long-term prognosis in CRT patients.
- To investigate the comparative benefit of CRT-D versus CRT-P.
- To identify predictors of mortality in CRT-treated heart failure patients.
Main Methods:
- Retrospective analysis of 705 patients treated with CRT-P or primary prophylactic CRT-D (1999-2012).
- Investigation of mortality predictors.
- Time-dependent analysis with all-cause mortality as the primary endpoint.
Main Results:
- Median follow-up was 59 months.
- Annual mortality was 5.3% for CRT-D and 11.8% for CRT-P.
- Adjusted analysis showed CRT-D was not associated with better long-term survival than CRT-P.
- Independent survival predictors included age, loop diuretics, hemoglobin, and RAAS blockers.
Conclusions:
- CRT-D treatment was not an independent predictor of long-term survival in this real-world CRT cohort.
- Further research needed to identify patients who benefit most from CRT-D over CRT-P.
- Optimizing patient selection is crucial for justifying CRT-D implantation.
Background:
Cardiac resynchronization therapy (CRT) with or without a defibrillator has a positive effect on mortality and morbidity for patients with heart failure. However, comparisons between CRT-defibrillators (CRT-D) and CRT-pacemakers (CRT-P) are relatively scarce outside the clinical trial setting. This study aimed to assess baseline characteristics in relation to long-term prognosis in patients treated with CRT, and to investigate the potential benefit of CRT-D versus CRT-P.
Methods:
Data were retrospectively collected from the medical records of all consecutive patients treated with CRT-P or primary prophylactic CRT-D at a large tertiary care center between 1999 and 2012. Predictors of mortality were investigated, and time-dependent analysis was performed with all-cause mortality as the primary end point.
Results:
A total of 705 patients were included (69.6 ± 10 years, 78% New York Heart Association classes III-IV, left ventricular ejection fraction median 25%, 16% female, 36% CRT-D). The patients were followed for a median of 59 months. Annual mortality differed between CRT-D primary prophylactic and CRT-P groups (5.3% and 11.8%, respectively), but when adjusted for covariates, CRT-D treatment (compared to CRT-P) was not associated with better long-term survival. Independent predictors of survival were: age, use of loop diuretics, hemoglobin levels, and use of renin angiotensin aldosterone system blockers.
Conclusions:
In CRT treatment outside of the clinical trial setting, CRT-D treatment was not an independent predictor of long-term survival. Future research should focus on correct selection of the patients who receive enough benefit of an added defibrillator to justify CRT-D implantation instead of CRT-P treatment only.
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