Survival of patients undergoing cardiac resynchronization therapy with or without defibrillator: the RESET-CRT...

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.