Key result
Immigrant status was not associated with a significant difference in 5-year all-cause mortality after CRT implantation compared with non-immigrants (24.1% vs 25.8%; HR 1.2, 95% CI 0.8-1.7, P=0.50).
Why the study?
Potential differences in outcomes for immigrants and non-immigrants with cardiac resynchronization therapy in a European setting remained unknown.
Does immigrant status affect heart failure-related hospitalizations and all-cause mortality in patients undergoing cardiac resynchronization therapy?
Cohort (n=8,224)
Yes
Does immigrant status affect heart failure-related hospitalizations and all-cause mortality in patients undergoing cardiac resynchronization therapy?
Hazard Ratio: 1.2 (95% CI 0.8–1.7)
Absolute Event Rate: 24.1% vs 25.8%
p-value: p=0.50
Immigrant status does not significantly impact overall 5-year mortality or the reduction in heart failure hospitalizations following CRT implantation in a European setting, though specific regional subgroups may face higher risks.
CRT shows comparable efficacy in immigrants and non-immigrants; extends real-world data but leaves subgroup disparities open.
AIMS: To date, potential differences in outcomes for immigrants and non-immigrants with a cardiac resynchronization therapy (CRT), in a European setting, remain underutilized and unknown. Hence, we examined the efficacy of CRT measured by heart failure (HF)-related hospitalizations and all-cause mortality among immigrants and non-immigrants. METHODS AND RESULTS: All immigrants and non-immigrants who underwent first-time CRT implantation in Denmark (2000-2017) were identified from nationwide registries and followed for up to 5 years. Differences in HF related hospitalizations and all-cause mortality were evaluated by Cox regression analyses. From 2000 to 2017, 369 of 10 741 (3.4%) immigrants compared with 7855 of 223 509 (3.5%) non-immigrants with a HF diagnosis underwent CRT implantation. The origins of the immigrants were Europe (61.2%), Middle East (20.1%), Asia-Pacific (11.9%), Africa (3.5%), and America (3.3%). We found similar high uptake of HF guideline-directed pharmacotherapy before and after CRT and a consistent reduction in HF-related hospitalizations the year before vs. the year after CRT (61% vs. 39% for immigrants and 57% vs. 35% for non-immigrants). No overall difference in 5-year mortality among immigrants and non-immigrants was seen after CRT [24.1% and 25.8%, respectively, P-value = 0.50, hazard ratio (HR) = 1.2, 95% confidence interval (CI): 0.8-1.7]. However, immigrants of Middle Eastern origin had a higher mortality rate (HR = 2.2, 95% CI: 1.2-4.1) compared with non-immigrants. Cardiovascular causes were responsible for the majority of deaths irrespective of immigration status (56.7% and 63.9%, respectively). CONCLUSION: No overall differences in efficacy of CRT in improving outcomes between immigrants and non-immigrants were identified. Although numbers were low, a higher mortality rate among immigrants of Middle Eastern origin was identified compared with non-immigrants.
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Krøll et al. (2023) conducted a cohort in Heart failure (n=8,224). Immigrant status vs. Non-immigrant status was evaluated on 5-year all-cause mortality (HR 1.2, 95% CI 0.8-1.7, p=0.50). Immigrant status was not associated with a significant difference in 5-year all-cause mortality after CRT implantation compared with non-immigrants (24.1% vs 25.8%; HR 1.2, 95% CI 0.8-1.7, P=0.50).
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