Survival of patients undergoing cardiac resynchronization therapy with or without defibrillator: the RESET-CRT
Moritz Hadwiger1, Nikolaos Dagres2,3, Janina Haug4
1Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Insights
Cardiac resynchronization therapy with a pacemaker (CRT-P) shows similar survival rates to therapy with a defibrillator (CRT-D) in heart failure patients. Initial survival differences were primarily due to age, not the device type.
Area of Science:
- Cardiology
- Medical Devices
- Health Outcomes Research
Background:
- Cardiac resynchronization therapy (CRT) is a standard treatment for heart failure.
- Evidence is conflicting regarding whether adding defibrillator capability (CRT-D) improves outcomes compared to pacemaker-only CRT (CRT-P).
Purpose of the Study:
- To compare the survival of patients receiving de novo CRT-D versus CRT-P.
- To investigate if defibrillator capability influences prognosis in CRT patients without a primary indication for defibrillation.
Main Methods:
- Analysis of a large German health claims database (2014-2019).
- Inclusion of patients with de novo CRT implantation without secondary prevention indication for defibrillators.
- Utilized age-adjusted Cox regression and entropy balancing for statistical analysis of 847 CRT-P and 2722 CRT-D patients.
Main Results:
- Initial unadjusted analysis showed higher mortality in CRT-P (HR: 1.63).
- After age adjustment and entropy balancing, no significant survival difference was observed between CRT-P and CRT-D (HR: 1.13 and 0.99, respectively).
- No survival disparities were found across different age groups.
Conclusions:
- CRT-P is not associated with inferior survival compared to CRT-D in contemporary practice.
- Observed initial survival differences were largely explained by age imbalances between groups.
- Findings suggest CRT-P may be a viable option when defibrillator capability is not otherwise indicated.
Aims:
Cardiac resynchronization therapy (CRT) is an established treatment for heart failure. There is contradictory evidence whether defibrillator capability improves prognosis in patients receiving CRT. We compared the survival of patients undergoing de novo implantation of a CRT with defibrillator (CRT-D) option and CRT with pacemaker (CRT-P) in a large health claims database.
Methods And Results:
Using health claims data of a major German statutory health insurance, we analysed patients with de novo CRT implantation from 2014 to 2019 without indication for defibrillator implantation for secondary prevention of sudden cardiac death. We performed age-adjusted Cox proportional hazard regression and entropy balancing to calculate weights to control for baseline imbalances. The analysis comprised 847 CRT-P and 2722 CRT-D patients. Overall, 714 deaths were recorded during a median follow-up of 2.35 years. A higher cumulative incidence of all-cause death was observed in the initial unadjusted Kaplan-Meier time-to-event analysis [hazard ratio (HR): 1.63, 95% confidence interval (CI): 1.38-1.92]. After adjustment for age, HR was 1.13 (95% CI: 0.95-1.35) and after entropy balancing 0.99 (95% CI: 0.81-1.20). No survival differences were found in different age groups. The results were robust in sensitivity analyses.
Conclusion:
In a large health claims database of CRT implantations performed in a contemporary setting, CRT-P treatment was not associated with inferior survival compared with CRT-D. Age differences accounted for the greatest part of the survival difference that was observed in the initial unadjusted analysis.
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