May 5, 2014Annals of Internal Medicine
Comparative Effectiveness of Cardiac Resynchronization Therapy With an Implantable Cardioverter-Defibrillator Versus Defibrillator Therapy Alone
Why the study?
Does cardiac resynchronization therapy with a defibrillator (CRT-D) reduce mortality and readmission compared to implantable cardioverter-defibrillator (ICD) therapy alone in older patients with reduced LVEF and prolonged QRS duration?
Population
7,090 propensity-matched patients older than 65 years with reduced left ventricular ejection fraction and…
Comparison
Cardiac resynchronization therapy with a… vs Implantable cardioverter-defibrillator therapy…
Design
Cohort
Follow-up
3 years
Authors
Discussion
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Implication
May inform CRT-D decisions in older HFrEF patients; extends trial data to real-world Medicare cohort but requires randomized confirmation.
Structured PICO
Does cardiac resynchronization therapy with a defibrillator (CRT-D) reduce mortality and readmission compared to implantable cardioverter-defibrillator (ICD) therapy alone in older patients with reduced LVEF and prolonged QRS duration?
P
Population
7,090 propensity-matched patients older than 65 years with reduced left ventricular ejection fraction (<0.35) and prolonged QRS duration on electrocardiography (≥120 ms) having CRT-D or ICD implantation between 1 April 2006 and 31 December 2009.
I
Intervention
Cardiac resynchronization therapy with a defibrillator (CRT-D)
C
Comparator
Implantable cardioverter-defibrillator (ICD) therapy alone
O
Outcome
Risks for death, readmission, and device-related complications over 3 yearshard clinical
In a real-world cohort of older Medicare patients with HFrEF and prolonged QRS, CRT-D was associated with significantly lower mortality and heart failure readmissions, but higher device-related infections, compared to ICD therapy alone.
Limitations
- Patients were not randomly assigned to treatment groups
- Few patients could be propensity-matched
- Findings may not extend to younger patients or those outside of fee-for-service Medicare
Cite This Study
Masoudi et al. (2014) studied this question.