CRT-upgrade plus standard heart failure medical therapy significantly reduced all-cause mortality compared with medical therapy alone in patients with PaHF (HR 0.36; 95% CI 0.26-0.50; P<0.001).
Cohort (n=4,166)
Yes
Does CRT-upgrade reduce all-cause mortality in patients with pacing-associated heart failure compared to medical therapy alone?
In patients with pacing-associated heart failure, upgrading to cardiac resynchronization therapy (CRT) significantly reduces all-cause mortality compared to medical therapy alone.
Effect estimate: HR 0.36 (95% CI 0.26-0.50)
p-value: p=<0.001
Abstract Background Pacing-associated heart failure (PaHF) has emerged as a clinically significant complication in patients with pacemakers, yet its prognostic factors and optimal management remain underexplored. We aimed to assess mortality risk and the clinical impact of cardiac resynchronization therapy (CRT)-upgrade and heart failure (HF) medications in patients with PaHF using a nationwide real-world cohort. Methods We analyzed 4,166 patients who developed PaHF after de novo permanent pacemaker implantation using a nationwide real-world cohort from the Korean National Health Insurance Service. To address confounding and immortal-time bias, propensity score matching and time-dependent Cox regression models were applied. Results During a median follow-up of 1.9 years, 330 patients underwent CRT-upgrade in addition to standard HF medical therapy, while 3,836 received guideline-directed HF medications alone. Increasing age (HR=1.05 per year, 95% CI 1.04–1.06, P0.001), male sex (HR=1.41, 95% CI 1.16–1.71, P0.001), diabetes (HR=1.28, 95% CI 1.02–1.60, P=0.035), and chronic kidney disease or end-stage renal disease (HR=1.69, 95% CI 1.32–2.17, P0.001) were independently associated with increased all-cause mortality. In contrast, CRT-upgrade (HR=0.36, 95% CI 0.26–0.50, P0.001), angiotensin receptor–neprilysin inhibitor (ARNI) use (HR=0.37, 95% CI 0.19–0.68, P=0.004), and beta-blockers (HR=0.80, 95% CI 0.64–0.99, P=0.042) were strongly associated with improved survival. Conclusion In this nationwide real-world cohort, CRT-upgrade was associated with a significant reduction in all-cause mortality compared with medical therapy alone in patients with PaHF. These findings support the prognostic importance of device-based therapy in combination with contemporary HF medical treatment in real-world clinical practice.
Park et al. (Sat,) conducted a cohort in Pacing-associated heart failure (PaHF) (n=4,166). Cardiac resynchronization therapy (CRT)-upgrade vs. Guideline-directed HF medications alone was evaluated on All-cause mortality (HR 0.36, 95% CI 0.26-0.50, p=<0.001). CRT-upgrade plus standard heart failure medical therapy significantly reduced all-cause mortality compared with medical therapy alone in patients with PaHF (HR 0.36; 95% CI 0.26-0.50; P<0.001).