Cardiac resynchronization therapy outcomes in patients with chronic heart failure: cardiac resynchronization therapy
Michael Drozd1, John Gierula, Judith E Lowry
1aLeeds Institute of Cardiovascular and Metabolic Medicine, University of LeedsbLeeds Teaching Hospitals NHS TrustcClinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK.
Insights
Cardiac resynchronization therapy with a defibrillator (CRT-D) did not show a survival benefit over a pacemaker (CRT-P) in heart failure patients. Patients needing CRT may not gain additional survival advantages from a defibrillator.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) improves survival in chronic heart failure with left ventricular systolic dysfunction (LVSD).
- Limited comparative data exist for CRT with a pacemaker (CRT-P) versus CRT with a defibrillator (CRT-D).
Purpose of the Study:
- To compare the long-term prognosis of patients receiving CRT-P versus CRT-D.
- To investigate survival outcomes between CRT-P and CRT-D in a large patient cohort.
Main Methods:
- Prospective data collection from 795 patients implanted with CRT devices between 2008 and 2012.
- Comparison of all-cause mortality between CRT-P and CRT-D groups.
- Subgroup analysis for patients with ischaemic cardiomyopathy.
Main Results:
- No significant survival benefit was observed for CRT-D compared to CRT-P (HR 1.09, P=0.51).
- A non-significant trend for improved survival with CRT-D was noted in ischaemic heart failure patients.
- No differences in mode-specific mortality were found between CRT-D and CRT-P.
Conclusions:
- CRT-D did not confer a survival advantage over CRT-P in this patient cohort.
- The addition of a defibrillator to CRT may not reliably improve survival for all indicated patients.
Aims:
Cardiac resynchronization therapy (CRT) for chronic heart failure with left ventricular systolic dysfunction (LVSD) consistently improves survival against optimal medical therapy alone. Limited data exist comparing the outcomes between CRT with pacemaker (CRT-P) and with defibrillator (CRT-D). We aimed to investigate the long-term prognosis of patients who received CRT-P or CRT-D.
Methods And Results:
Data were prospectively collected from consecutive patients with standard indications for CRT, who were implanted at a single large tertiary centre between 2008 and 2012. All-cause mortality was compared between those patients who received either CRT-P or CRT-D. A subgroup analysis was performed in patients with ischaemic cardiomyopathy. During the period in question, 795 patients received CRT devices: 544 (68.4%) CRT-P and 251 (31.6%) CRT-D. The mean follow-up was 1072 ± (SD 556) days. Overall, there was no survival benefit in those patients implanted with a CRT-D compared with CRT-P (hazard ratio 1.09, 95% confidence interval 0.84-1.41, P = 0.51). In patients with ischaemic chronic heart failure [n = 530 (66.7%)], there was a trend for improved survival with CRT-D; however, this was not significant after adjustment. In a subgroup analysis, there were no differences in mode-specific mortality in those patients implanted with CRT-D compared with CRT-P.
Conclusion:
In this large consecutive patient cohort, we did not find a survival benefit of CRT-D compared with CRT-P. Patients indicated for CRT devices may not reliably benefit from the addition of a defibrillator.
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