Implantable Defibrillators Improve Survival in Patients With Mildly Symptomatic Heart Failure Receiving Cardiac Resynchronization Therapy
Key result
Cardiac resynchronization therapy with a defibrillator (CRT-D) was associated with improved long-term survival compared to CRT pacing alone in mild heart failure (HR 0.35; P=0.003).
Why the study?
Does CRT-D improve long-term survival compared to CRT-P in patients with mildly symptomatic heart failure?
Population
419 patients with mildly symptomatic heart failure who were randomized to the active CRT group in the…
Comparison
Cardiac resynchronization therapy with… vs Cardiac resynchronization therapy pacemaker…
Design
Cohort, Not randomized for device type; parent trial was randomized for active…
Follow-up
5 years
Authors
Discussion
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Implication
CRT-D may offer survival advantage over CRT-P in mild HF; leaves open need for randomized confirmation before practice change.
Study Design
Type
RCT (n=419)
Randomization
randomized
Multicenter
Yes
Structured PICO
Does CRT-D improve long-term survival compared to CRT-P in patients with mildly symptomatic heart failure?
P
Population
419 patients with mild heart failure randomized to active CRT (345 receiving CRT-D and 74 receiving CRT-pacemaker), with a preplanned follow-up of 5 years.
I
Intervention
Cardiac resynchronization therapy with defibrillator backup (CRT-D) (n=345)
C
Comparator
Cardiac resynchronization therapy pacemaker (CRT-P) (n=74), implanted based on national guidelines
O
Outcome
Long-term survival (mortality) over 5 yearshard clinical
Main Result
Hazard Ratio: 0.35
p-value: p=0.003
In patients with mildly symptomatic heart failure, receiving a CRT-D device rather than a CRT-P device is associated with significantly improved long-term survival.
Cite This Study
Gold et al. (2013) conducted an RCT in mild heart failure (n=419). CRT-D (cardiac resynchronization therapy with defibrillator) vs. CRT-pacemaker was evaluated on survival (HR 0.35, p=0.003). Cardiac resynchronization therapy with a defibrillator (CRT-D) was associated with improved long-term survival compared to CRT pacing alone in mild heart failure (HR 0.35; P=0.003).