Key result
CRT-D cuts heart failure or death ~34% vs. ICD alone in mildly symptomatic HFrEF.
Why the study?
The MADIT trials were conducted to improve outcomes for patients with ischemic and nonischemic cardiac disease using implantable defibrillator and resynchronization devices.
Does CRT-D reduce the risk of heart failure or death compared to ICD in asymptomatic or minimally symptomatic patients with reduced ejection fraction and wide QRS?
Population
Patients with ischemic and nonischemic cardiac disease including asymptomatic or minimally symptomatic with reduced ejection fraction ≤0.30 and wide QRS ≥130 ms
Comparison
CRT-D device versus ICD device in MADIT-CRT trial
Design
Series of multicenter randomized trials including MADIT-I, MADIT-II, and MADIT-CRT
Authors
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Supports CRT-D consideration in low-symptom patients; leaves open optimal QRS thresholds and long-term effects in contemporary cohorts.
Does CRT-D reduce the risk of heart failure or death compared to ICD in asymptomatic or minimally symptomatic patients with reduced ejection fraction and wide QRS?
Hazard Ratio: 0.66
p-value: p=0.001
The MADIT family of trials established a firm foundation for the use of ICDs and CRT-Ds to improve outcomes in at-risk cardiac patients with ischemic and nonischemic disease.
Arthur J. Moss (2010) conducted a review in Ischemic or nonischemic heart disease (n=1,820). Cardiac resynchronization therapy device with defibrillator (CRT-D) vs. Implantable cardiac defibrillator (ICD) was evaluated on Death from any cause or non-fatal heart failure (HR 0.66, p=0.001). Prophylactic cardiac resynchronization therapy with a defibrillator reduced the risk of heart failure or death by 34% (HR 0.66, P=0.001) compared to an ICD alone in minimally symptomatic patients with reduced ejection fraction and wide QRS.
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