Improved outcomes of cardiac resynchronization therapy with a defibrillator in systolic heart failure: Analysis of the Japan cardiac device treatment registry database

Background Temporal change in outcomes of heart failure patients receiving cardiac resynchronization therapy with a defibrillator (CRT‐D) is unknown. Methods We assess outcomes and underlying heart diseases of patients receiving CRT‐D with analyzing database of the Japan cardiac device treatment registry (JCDTR) at the implantation year 2011–2015 and New JCDTR at the implantation year 2018–2021. Results Proportion of nonischemic heart diseases was about 70% in both the groups (JCDTR: 69%; New JCDTR: 72%). Cardiac sarcoidosis increased with the rate of 5% in the JCDTR to 9% in the New JCDTR group. During an average follow‐up of 21 months, death from any cause occurred in 167 of 906 patients in the JCDTR group (18%) and 79 of 611 patients in the New JCDTR group (13%) (adjusted hazard ratio [aHR] in the New JCDTR group, 0.72; 95% confidence interval [CI]: 0.55–0.94; p = .017). The superiority was mainly driven by reduction in the risk of noncardiac death. With regard to appropriate and inappropriate implantable cardioverter–defibrillator (ICD) therapy, there was a significant reduction in the New JCDTR group versus the JCDTR group (aHR in the New JCDTR group, 0.76; 95% CI: 0.59–0.98; p = .032 for appropriate ICD therapy; aHR in the New JCDTR group, 0.24; 95% CI: 0.12–0.50; p < .0001 for inappropriate ICD therapy). Conclusions All‐cause mortality was reduced in CRT‐D patients implanted during 2018–2021 compared to those during 2011–2015, with a significant reduction in noncardiac death.