Key result
Surgical treatments including CRT cut overall mortality ~33% versus medical therapy in severe heart failure.
Why the study?
Does surgical treatment (CRT, CRT-D, CSS, HT) reduce overall mortality compared to medical therapy or control in patients with severe chronic heart failure?
Meta-Analysis (n=30,257)
Does surgical treatment (CRT, CRT-D, CSS, HT) reduce overall mortality compared to medical therapy or control in patients with severe chronic heart failure?
Surgical treatments, including CRT, CRT-D, circulatory support, and heart transplantation, significantly reduce overall mortality in severe chronic heart failure compared to traditional medical therapy.
Answers are grounded in this paper and cite their sources.
Supports CRT/CRT-D and CSS/HT over medical therapy alone for mortality reduction in severe HF; reinforces guideline-directed use.
Aim -Meta-analysis of clinical trials comparing the efficacy of medical therapy (MT) and surgical treatment, including cardiac resynchronization therapy with and without cardioversion-defibrillation (CRT and CRT-D), circulatory support system (CSS) and heart transplantation (HT), in terms of decreasing overall mortality in patients with severe chronic heart failure (CHF). Material and Methods -Meta-analysis included 39 clinical trials with a total number of 30,257 patients. Search was performed in MEDLINE, Medscape, Pubmed databases and on web resources, dedicated to clinical trials (National Institutes of Health, Clinical Center, ClinicalStudyResults.org, ClinicalTrials.gov). Results -There was no significant overall mortality reduction in patients receiving MT when compared to control group: OR=0.97 (95% CI: 0.85-1.10), p=0.211. Treatment with CRT and CRT-D, as well as CSS implantation and HT reduced overall mortality: OR=0.67 (95% CI: 0.57-0.79), p < 0.001 for CRT/CRT-D and OR=0.46 (95% CI: 0.24-0.86), p = 0.018 for CSS/HT. Conclusion -Superiority of surgical treatment over traditional MT in terms of overall mortality was observed in patients with severe CHF.
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Olanna T. Kotsoeva (2016) conducted a meta-analysis in severe chronic heart failure (CHF) (n=30,257). Surgical treatment (CRT, CRT-D, CSS, HT) vs. Medical therapy (MT) was evaluated on overall mortality (OR 0.67, 95% CI 0.57-0.79, p=< 0.001). Surgical treatments including CRT/CRT-D (OR 0.67) and CSS/HT (OR 0.46) demonstrated superiority over medical therapy in reducing overall mortality in patients with severe chronic heart failure.
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