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Clinical Effectiveness of Cardiac Resynchronization Therapy vs Medical Therapy Alone Among Patients With Heart Failure: An Analysis of the ICD and ADHERE National Registries.
Circ Heart Fail. 2014 Sep 16;
Authors: Khazanie P, Hammill BG, Qualls LG, Fonarow GC, Hammill SC, Heidenreich PA, Al-Khatib SM, Piccini JP, Masoudi FA, Peterson PN, Curtis JP, Hernandez AF, Curtis LH
Abstract
BACKGROUND: -Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality among selected patients with heart failure in clinical trials. The effectiveness of this therapy in clinical practice has not been well studied.
METHODS AND RESULTS: -We compared a cohort of 4471 patients from the National Cardiovascular Data Registry's ICD Registry™ hospitalized primarily for heart failure and who received CRT-D between April 1, 2006, and December 31, 2009, to a historical control cohort of 4888 patients with heart failure without CRT-D from the Acute Decompensated Heart Failure National Registry hospitalized between January 1, 2002, and March 31, 2006. Both registries were linked with Medicare claims to evaluate longitudinal outcomes. We included patients from the ICD Registry with left ventricular ejection fraction of 35% or less and QRS duration of 120 ms or greater who were admitted for heart failure. We used Cox proportional hazards models to compare outcomes with and without CRT-D after adjustment for important covariates. After multivariable adjustment, CRT-D was associated with lower 3-year risks of death (hazard ratio, 0.52; 95% CI, 0.48-0.56; P < .001), all-cause readmission (hazard ratio, 0.69; 95% CI, 0.65-0.73; P < .001), and cardiovascular readmission (hazard ratio, 0.60; 95% CI, 0.56-0.64; P < .001). The association of CRT-D with mortality did not vary significantly among subgroups defined by age, sex, race, QRS duration, and optimal medical therapy.
CONCLUSIONS: -CRT-D was associated with lower risks of mortality, all-cause readmission, and cardiovascular readmission than medical therapy alone among patients with heart failure in community practice.
PMID: 25227768 [PubMed - as supplied by publisher]