Key result
Combined cardiac resynchronization and ICD therapy was associated with a significant reduction in mortality compared to ICD therapy alone (RR 0.32; P=0.0006).
Why the study?
Does cardiac resynchronization therapy plus an implantable cardioverter-defibrillator reduce appropriate ICD shocks and mortality in patients with heart failure compared to an implantable cardioverter-defibrillator alone?
Cohort (n=529)
Does cardiac resynchronization therapy plus an implantable cardioverter-defibrillator reduce appropriate ICD shocks and mortality in patients with heart failure compared to an implantable cardioverter-defibrillator alone?
Relative Risk: 0.32
p-value: p=0.0006
In heart failure patients with reduced ejection fraction, CRT and statin therapy are associated with significantly reduced mortality, and statins are associated with fewer appropriate ICD shocks.
Of 529 patients with heart failure and a mean left ventricular ejection fraction of 29%, 209 (40%) were treated with cardiac resynchronization therapy (CRT) plus an implantable cardioverter-defibrillator (ICD) and 320 (60%) with an ICD. Mean follow-up was 34 months for both groups. Stepwise logistic regression analysis showed that significant independent variables for appropriate ICD shocks were statins (risk ratio = 0.35, P < .0001), smoking (risk ratio = 2.52, P < .0001), and digoxin (risk ratio = 1.92, P = .0001). Significant independent variables for time to deaths were use of CRT (risk ratio = 0.32, P = .0006), statins (risk ratio = 0.18, P < .0001), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (risk ratio = 0.10, P < .0001), hypertension (risk ratio = 24.15, P < .0001), diabetes (risk ratio = 2.54, P = .0005), and age (risk ratio = 1.06, P < .0001). In conclusion, statins reduced and smoking and digoxin increased appropriate ICD shocks. Use of CRT, statins, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers reduced mortality and hypertension, diabetes, and older age increased mortality.
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Desai et al. (2009) conducted a cohort in heart failure (n=529). Cardiac resynchronization therapy (CRT) plus implantable cardioverter-defibrillator (ICD) vs. Implantable cardioverter-defibrillator (ICD) alone was evaluated on time to deaths (RR 0.32, p=0.0006). Combined cardiac resynchronization and ICD therapy was associated with a significant reduction in mortality compared to ICD therapy alone (RR 0.32; P=0.0006).
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