Effects of Cardiac Resynchronization Therapy on Cardiovascular and Noncardiovascular Hospitalization: A MADIT-CRT
Sabu Thomas1,2, Scott McNitt2, Bronislava Polonsky2
1Division of Cardiology University of Rochester School of Medicine Rochester NY USA.
Insights
Cardiac resynchronization therapy with defibrillation (CRT-D) significantly reduces hospitalizations for heart failure and cardiovascular events compared to implantable cardioverter-defibrillators (ICD). This therapy also shortens hospital stays, highlighting its long-term benefits.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Cardiac resynchronization therapy with defibrillation (CRT-D) is known to improve heart failure outcomes.
- The long-term impact of CRT-D on hospitalization rates in heart failure patients remained unclear.
- Understanding hospitalization trends is crucial for managing heart failure and optimizing device therapy.
Purpose of the Study:
- To evaluate the long-term effects of CRT-D versus implantable cardioverter-defibrillator (ICD) on hospitalization rates.
- To compare cardiovascular, heart failure (HF), and noncardiovascular hospitalizations between CRT-D and ICD groups.
- To assess the impact of CRT-D on length of stay and mortality associated with hospitalizations.
Main Methods:
- Post hoc analysis of the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT) study.
- Comparison of hospitalization rates, length of stay, and mortality between patients receiving CRT-D and ICD.
- Extended follow-up period to assess long-term outcomes.
Main Results:
- CRT-D significantly reduced overall hospitalization rates (37.9 vs. 44.3 events/100 patient-years, P=0.033).
- Cardiovascular (20.8 vs. 28.3 events/100 patient-years, P<0.001) and heart failure hospitalizations (6.8 vs. 11.6 events/100 patient-years, P<0.001) were lower with CRT-D.
- Noncardiovascular hospitalizations showed no significant difference (17 vs. 16 events/100 patient-years, P=0.368); however, CRT-D shortened hospital stays for cardiovascular and HF events.
Conclusions:
- CRT-D is associated with reduced rates and shorter durations of cardiovascular and heart failure hospitalizations compared to ICD alone.
- Hospitalization, irrespective of the cause, is a strong predictor of increased mortality.
- These findings underscore the long-term benefits of CRT-D in managing heart failure patients.
Background:
Cardiac resynchronization therapy with defibrillation (CRT-D) improves outcomes in heart failure. The long-term impact of CRT-D on hospitalizations remains unknown.
Methods:
We analyzed the MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) trial post hoc to assess the effects of CRT-D versus implantable cardioverter-defibrillator (ICD) on cardiovascular, heart failure (HF), and noncardiovascular hospitalizations. Hospitalization rates, length of stay, and mortality were compared during extended follow-up.
Results:
Patients receiving CRT-D had lower rates of hospitalization compared with ICD (37.9 events per 100 patient-years versus 44.3 events per 100 patient-years, P=0.033). Rates of cardiovascular hospitalizations (20.8 versus 28.3 events per 100 patient-years; P<0.001) and heart failure hospitalizations (6.8 versus 11.6 events per 100 patient-years; P<0.001) were lower with CRT-D. There was no difference in noncardiovascular hospitalizations in the CRT-D group compared with ICD (17 versus 16 events per 100 patient-years, P=0.368). The average length of stay for cardiovascular hospitalizations was shorter in the CRT-D group versus the ICD group (6.7±0.89 versus 7.7±0.68 days; P<0.001), as was the length of stay for heart failure hospitalizations (4.2±0.79 versus 4.8±0.58 days; P<0.001). No difference was observed in the length of stay for noncardiovascular hospitalizations (8.1 versus 7.0 days; P=0.082). Hospitalization of any type was associated with a markedly increased risk of death (hazard ratio, 8.97 [95% CI, 6.17-13.05]; P<0.0001).
Conclusions:
Among patients in MADIT-CRT, CRT-D was associated with lower rates and shorter durations of all cardiovascular hospitalizations, including heart failure hospitalizations compared with ICD alone. Hospitalization, regardless of cause, was strongly associated with increased mortality.
Registration:
https://clinicaltrials.gov/study/NCT00180271.
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