The shocking lack of evidence for implantable cardioverter defibrillators for heart failure; with or without cardiac resynchronization
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Key result
Current observational evidence shows no significant difference in all-cause mortality or sudden death between CRT-D and CRT-P in heart failure patients, underscoring the urgent need for randomized controlled trials.
Why the study?
Does CRT-D improve survival compared to CRT-P in patients with heart failure and reduced ejection fraction?
Structured PICO
Does CRT-D improve survival compared to CRT-P in patients with heart failure and reduced ejection fraction?
P
Population
Patients with heart failure and a reduced left ventricular ejection fraction (HFrEF) receiving cardiac resynchronization therapy (CRT)
I
Intervention
Cardiac resynchronization therapy with defibrillator (CRT-D)
C
Comparator
Cardiac resynchronization therapy pacemaker (CRT-P)
O
Outcome
All-cause mortality and sudden deathhard clinical
Limitations
- Observational studies comparing CRT-D and CRT-P are limited by unmeasured confounders and baseline differences in age and comorbidities.
- High rates of missing data or exclusion in existing observational cohorts.
- Non-randomized data
- Statistical methodologies cannot account for unmeasured confounders
- Potential bias from differences in mortality prior to the 5-year baseline
- Missing data (analysis included only 1775 of 5782 initially enrolled patients)
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Discussion
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Implication
This editorial highlights the lack of robust randomized evidence supporting a survival benefit of CRT-D over CRT-P in heart failure patients, advocating for ongoing randomized trials to guide clinical decision-making.
Cite This Study
Cleland et al. (2019) conducted an editorial in Heart failure. Implantable cardioverter defibrillators (CRT-D) vs. Cardiac resynchronization therapy pacemakers (CRT-P) was evaluated. Current observational evidence shows no significant difference in all-cause mortality or sudden death between CRT-D and CRT-P in heart failure patients, underscoring the urgent need for randomized controlled trials.
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