Cardiac resynchronization therapy pacemakers significantly reduced all-cause mortality (HR 0.68; 95% CI 0.56-0.81; p<0.0001) and the composite of heart failure hospitalization or mortality.
Meta-Analysis (n=1,738)
Yes
Does CRT-P reduce all-cause mortality and the composite of heart failure hospitalization or mortality in patients with heart failure, reduced LVEF, QRS >130 ms, and sinus rhythm?
CRT-P significantly reduces all-cause mortality and the composite of heart failure hospitalization or mortality in appropriately selected heart failure patients, with potentially greater benefits in smaller patients and those receiving beta-blockers.
Effect estimate: HR 0.68 (95% CI 0.56-0.81)
p-value: p=<0.0001
AIMS: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically, of CRT pacemakers (CRT-P) on all-cause mortality or the composite of hospitalization for heart failure or all-cause mortality. METHODS AND RESULTS: We conducted an individual patient data meta-analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization-Heart Failure (CARE-HF) trials. Only patients assigned to CRT-P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. Median age was 67 (59-73) years, most patients were men (70%), 68% had a QRS duration of 150-199 ms and 80% had left bundle branch block. Patients assigned to CRT-P had lower rates for all-cause mortality (hazard ratio HR 0.68, 95% confidence interval CI 0.56-0.81; p < 0.0001) and the composite outcome (HR 0.67, 95% CI 0.58-0.78; p < 0.0001). No pre-specified characteristic, including sex, aetiology of ventricular dysfunction, QRS duration (within the studied range) or morphology or PR interval significantly influenced the effect of CRT-P on all-cause mortality or the composite outcome. However, CRT-P had a greater effect on the composite outcome for patients with lower body surface area and those prescribed beta-blockers. CONCLUSIONS: Cardiac resynchronization therapy-pacemaker reduces morbidity and mortality in appropriately selected patients with heart failure. Benefits may be greater in smaller patients and in those receiving beta-blockers. Neither QRS duration nor morphology independently predicted the benefit of CRT-P. CLINICAL TRIAL REGISTRATION: COMPANION, NCT00180258; CARE-HF, NCT00170300.
Cleland et al. (Sun,) conducted a meta-analysis in Heart failure (n=1,738). Cardiac resynchronization therapy pacemakers (CRT-P) vs. Control was evaluated on All-cause mortality (HR 0.68, 95% CI 0.56-0.81, p=<0.0001). Cardiac resynchronization therapy pacemakers significantly reduced all-cause mortality (HR 0.68; 95% CI 0.56-0.81; p<0.0001) and the composite of heart failure hospitalization or mortality.