What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=312). Intervention: CRT-D vs. ICD only. Primary outcome: overall mortality (p=0.038).

What question did this study set out to answer?

To determine if heart failure patients with prolonged QRS benefit from CRT-D compared to those with narrow QRS receiving ICD alone.

November 26, 2015EP EuropaceOpen Access

Reduced long-term overall mortality in heart failure patients with prolonged QRS treated with CRT combined with ICD vs. heart failure patients with narrow QRS treated with ICD only

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Key result

Heart failure patients with prolonged QRS receiving CRT-D had significantly lower overall mortality compared to patients with narrow QRS receiving ICD only (P=0.038).

Why the study?

Does CRT-D reduce long-term overall mortality in heart failure patients with prolonged QRS compared to ICD only in heart failure patients with narrow QRS?

Key Points

To determine if heart failure patients with prolonged QRS benefit from CRT-D compared to those with narrow QRS receiving ICD alone.
312 heart failure patients included (mean age 66 years; 84% male).
138 patients with QRS duration ≥120 ms received CRT-D.
Median follow-up of 46 months, assessed time and cause of death.
CRT-D patients had significantly lower overall mortality (P = 0.038).
CRT-D patients had lower heart failure mortality compared to ICD-only patients (P = 0.003).
Coronary, non-cardiac, and sudden mortality were similar in both groups (all P > 0.05).

Study Design

Type

Cohort (n=312)

Structured PICO

Does CRT-D reduce long-term overall mortality in heart failure patients with prolonged QRS compared to ICD only in heart failure patients with narrow QRS?

Population

312 heart failure patients (mean age 66 years, 16% female, mean LVEF 25%) receiving either CRT-D for prolonged QRS or ICD only for narrow QRS, followed for a median of 46 months.

Exposure

Cardiac resynchronization therapy combined with a defibrillator (CRT-D) in patients with prolonged QRS (≥120 ms) (n=138)

Comparator

Implantable cardioverter defibrillator (ICD) only in patients with narrow QRS

Outcome

Long-term overall mortalityhard clinical

Main Result

p-value: p=0.038

In heart failure patients, those with prolonged QRS receiving CRT-D have better long-term survival than those with narrow QRS receiving ICD only, driven by reduced heart failure mortality.

Discussion

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Implication

Registry data leave open whether CRT-D improves survival versus ICD in HF; RCTs needed.

Cite This Study

Palmisano et al. (2015) conducted a cohort in Heart failure (n=312). CRT-D vs. ICD only was evaluated on overall mortality (p=0.038). Heart failure patients with prolonged QRS receiving CRT-D had significantly lower overall mortality compared to patients with narrow QRS receiving ICD only (P=0.038).

synapsesocial.com/papers/6a6384bc6a6e856b790957aa https://doi.org/10.1093/europace/euv347

Topics

Cardiac device therapy Heart failure HFrEF treatment Heart failure hospitalization

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Reduced long-term overall mortality in heart failure patients with prolonged QRS treated with CRT combined with ICD vs. heart failure patients with narrow QRS treated with ICD only

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Topics

Reduced long-term overall mortality in heart failure patients with prolonged QRS treated with CRT combined with ICD vs. heart failure patients with narrow QRS treated with ICD only

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider