CRT-D improves survival, symptom control compared with CRT-P
MedWire News: Cardiac resynchronization defibrillators (CRT-D) improve survival rates and symptom control of heart failure patients compared with cardiac resynchronization pacing (CRT-P) alone, 1-year results from the European CRT survey show.
These findings suggest that the benefits of CRT observed in randomized controlled trials can be replicated in routine clinical practice, report Nigussie Bogale (University of Bergen, Norway) and co-authors.
They enrolled 2438 patients who had a successful CRT implantation in 13 countries between November 2008 and June 2009. Follow-up data over 9-15 months were available for 2111 patients.
The study population included groups of patients who have been poorly represented in previous trials, including very elderly patients, those with prior device implantation, atrial fibrillation, and/or a QRS duration of less than 120 milliseconds, note the authors.
During follow-up, 207 (10%) patients died, 346 (16%) were hospitalized for cardiovascular (CV) causes, and 501 (24%) were hospitalized for CV causes or died.
Unadjusted Kaplan-Meir survival estimates suggested that patients who received a CRT-D had a significantly better prognosis than those who received a CRT-P (p<0.0002).
In addition, women had a better outcome than men, being hospitalized significantly less frequently (p<0.05).
Multivariate analysis revealed that New York Heart Association (NYHA) functional classes III-IV, atrial fibrillation, ischemic etiology, and allocation to CRT-P were independently associated with poor survival.
According to patients' self-reported assessment of their global condition, 81% of patients felt much better/a little better, 16% reported no change, and 4% reported feeling worse after receiving a CRT device compared with their pre-implant assessment.
Further analysis revealed a substantial improvement in NYHA functional class during follow-up. Indeed, the proportion of patients classified as NYHA I-II rose from 536 (22%) at the time of implant to 995 (50%) patients at follow-up.
"Although prospective, this is an observational study of successful CRT implantations, and outcomes in subgroup analyses must be interpreted with appropriate conservatism," say the authors.
"Further randomized trials comparing CRT-Ps with CRT-Ds would be desirable in patients with atrial fibrillation and in patients who do not have a substantial increase in QRS duration," they conclude in the European Journal of Heart Failure.
MedWire (http://www.medwire-news.md/) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Piriya Mahendra