Key result
CRT reduces heart failure hospitalization or mortality ~31% regardless of prior AF.
Why the study?
The association of cardiac resynchronization therapy on outcomes among patients with versus without a history of atrial fibrillation required investigation.
Does cardiac resynchronization therapy reduce heart failure hospitalization or all-cause mortality in patients with and without a history of atrial fibrillation?
Meta-Analysis (n=3,964)
Yes
Does cardiac resynchronization therapy reduce heart failure hospitalization or all-cause mortality in patients with and without a history of atrial fibrillation?
Effect estimate: HR 0.69 (95% CI 0.56-0.81)
CRT provides similar relative benefits for the composite of heart failure hospitalization or mortality in eligible patients regardless of a prior history of atrial fibrillation, though statistical power was limited.
Supports CRT in eligible HF patients regardless of AF history; extends RCT evidence to this common subgroup.
AIMS: To investigate the association of cardiac resynchronization therapy (CRT) on outcomes among participants with and without a history of atrial fibrillation (AF). METHODS: Individual-patient-data from four randomized trials investigating CRT-Defibrillators (COMPANION, MADIT-CRT, REVERSE) or CRT-Pacemakers (COMPANION, MIRACLE) were analyzed. Outcomes were time to a composite of heart failure hospitalization or all-cause mortality or to all-cause mortality alone. The association of CRT on outcomes for patients with and without a history of AF was assessed using a Bayesian-Weibull survival regression model adjusting for baseline characteristics. RESULTS: Of 3964 patients included, 586 (14.8%) had a history of AF; 2245 (66%) were randomized to CRT. Overall, CRT reduced the risk of the primary composite endpoint (hazard ratio [HR]: 0.69, 95% credible interval [CI]: 0.56-0.81). The effect was similar (posterior probability of no interaction = 0.26) in patients with (HR: 0.78, 95% CI: 0.55-1.10) and without a history of AF (HR: 0.67, 95% CI: 0.55-0.80). In these four trials, CRT did not reduce mortality overall (HR: 0.82, 95% CI: 0.66-1.01) without evidence of interaction (posterior probability of no interaction = 0.14) for patients with (HR: 1.09, 95% CI: 0.70-1.74) or without a history of AF (HR: 0.70, 95% CI: 0.60-0.97). CONCLUSION: The association of CRT on the composite endpoint or mortality was not statistically different for patients with or without a history of AF, but this could reflect inadequate power. Our results call for trials to confirm the benefit of CRT recipients with a history of AF.
No takes yet. Share an insight, caveat, or question.
Dalgaard et al. (2023) conducted a meta-analysis in Heart failure with or without a history of atrial fibrillation (n=3,964). Cardiac resynchronization therapy (CRT) vs. Control (no CRT) was evaluated on Composite of heart failure hospitalization or all-cause mortality (HR 0.69, 95% CI 0.56-0.81). Cardiac resynchronization therapy reduced heart failure hospitalization or mortality overall (HR 0.69; 95% CI 0.56-0.81), with similar effects in patients with and without prior atrial fibrillation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: