Key result
CRT upgrades linked to ~190% greater mortality risk versus de novo implantation in HF.
Why the study?
While cardiac resynchronization therapy is beneficial for heart failure with left bundle branch block, its benefits in patients with prior cardiac stimulation remain uncertain.
Does upgrade to cardiac resynchronization therapy reduce all-cause mortality compared to de novo implantation in patients with heart failure?
Cohort (n=412)
No
Does upgrade to cardiac resynchronization therapy reduce all-cause mortality compared to de novo implantation in patients with heart failure?
Effect estimate: HR 2.90 (95% CI 1.21-7.10)
Absolute Event Rate: 35.6% vs 27.6%
p-value: p=0.002
In a heart failure cohort with a high prevalence of Chagas cardiomyopathy, upgrading to CRT was associated with a nearly 3-fold higher risk of mortality compared to de novo CRT implantation.
May warrant caution with CRT upgrades in HF; leaves open whether selection bias or procedural factors explain the association.
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Carvalho et al. (2024) conducted a cohort in Heart Failure (n=412). Upgrade cardiac resynchronization therapy (CRT) vs. De novo cardiac resynchronization therapy (CRT) was evaluated on Overall mortality (HR 2.90, 95% CI 1.21-7.10, p=0.002). In patients with heart failure, upgrading to cardiac resynchronization therapy was associated with a significantly higher risk of overall mortality compared to de novo implantation (HR 2.90).
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