Comparison of CRT and CRT-D in heart failure: Systematic review of controlled trials

Jiang, Meng; He, Ben; Zhang, Qi

doi:10.1016/j.ijcard.2010.12.091

Cited by 15 publications

(8 citation statements)

References 23 publications

(39 reference statements)

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“…However, this trial supported only the advantages of CRT-P over OPT and CRT-D over OPT. There is no broad consensus on the advantages of CRT-D over CRT-P, even though a meta-analysis showed some superiority of the former on all-cause death rate and cardiac death after 1-year follow-up [3]. Other studies pointed out that CRT-D may be especially beneficial to a particular group of patients, like women, those with longer QRS duration, and smaller baseline LV volumes [42].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical trials have shown that CRT may decrease the risk of death from any cause for CHF patients by 24 % during a mean follow-up time of 16 months (COMPANION study, [1]) to 36 % during a mean follow-up of 29.4 months (CARE-HF study [2]). The addition of an implantable cardioverter defibrillator to the resynchronization therapy (CRT-D) can further reduce the risk of death from any cause by more than 8 % (compared to CRT-P) [3], while the risk of sudden death (SCD) can be reduced by 23 % [4–6]. However, overall costs of CRT-D are high and it is reported that about 25 to 35 % of the patients do not respond to CRT-P [7] while implantable cardioverter defibrillators (ICDs) are not always needed to deliver the therapy [5].…”

Section: Introductionmentioning

confidence: 99%

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A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

2016

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ObjectivesCardiac resynchronization therapy with a biventricular pacemaker (CRT-P) is an effective treatment for dyssynchronous heart failure (DHF). Adding an implantable cardioverter defibrillator (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, if the majority of patients do not require shock therapy, the cost-effectiveness ratio of CRT-D compared to CRT-P may be high. The objective of this study was to systematically review decision models evaluating the cost-effectiveness of CRT-D for patients with DHF, compare the structure and inputs of these models and identify the main factors influencing the ICERs for CRT-D.MethodsA comprehensive search strategy of Medline (Ovid), Embase (Ovid) and EconLit identified eight cost-effectiveness models evaluating CRT-D against optimal pharmacological therapy (OPT) and/or CRT-P.ResultsThe selected economic studies differed in terms of model structure, treatment path, time horizons, and sources of efficacy data. CRT-D was found cost-effective when compared to OPT but its cost-effectiveness became questionable when compared to CRT-P.ConclusionsCost-effectiveness of CRT-D may increase depending on improvement of all-cause mortality rates and HF mortality rates in patients who receive CRT-D, costs of the device, and battery life. In particular, future studies need to investigate longer-term mortality rates and identify CRT-P patients that will gain the most, in terms of life expectancy, from being treated with a CRT-D.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

2016

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“…The risks of lead problems and coronary dissection were significantly higher in patients who received CRT-D which remained a concern 6. A recent systematic review showed some benefits of CRT-D over CRT-P in the all-cause death rate after 1-year follow-up 7. However, the crucial question regarding the choice of appropriate device in the longer term remains unanswered and deciding which patients may benefit from the added defibrillator device is challenging.…”

Section: Introductionmentioning

confidence: 99%

Cardiac resynchronisation therapy: pacemaker versus internal cardioverter-defibrillator in patients with impaired left ventricular function

Looi

Gajendragadkar

Khan

et al. 2014

Heart

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Objective Studies have shown beneficial effects of cardiac resynchronisation therapy (CRT) on mortality among patients with heart failure. However the incremental benefits in survival from CRT with a defibrillator (CRT-D) are unclear. The choice of appropriate device remains unanswered. Method This is a single-centre observational study in a tertiary cardiac centre. Patients (n=500) implanted with a CRT device with pacing alone (CRT-P) (n=354) and CRT-D (n=146) were followed for at least 2 years (mean 29 months, SD 14 months). The primary end point was all-cause mortality. Results A total of 116 deaths (23.2%) were recorded: 88 (24.8%) and 28 (19.2%), in the CRT-P and CRT-D groups, respectively. At 1 year there was a trend favouring CRT-D (HR 0.54, 95% CI 0.27 to 1.07, p=0.08) but this was attenuated by the 2nd year and became insignificant at the end of follow-up (HR 0.76, 95% CI 0.50 to 1.170, p=0.21). There was no survival benefit from having an internal cardioverter-defibrillator if patients were deemed non-responders to CRT. 27% of the CRT-P patients with ischaemic cardiomyopathy met indications for potential internal cardioverter-defibrillator implantation for primary prevention. These were older patients with poorer baseline function in comparison with CRT-D patients with devices for primary prevention. Once these differences were adjusted for, there was no difference in outcome between the groups. Conclusions CRT-D did not offer additional survival advantage over CRT-P at longer-term follow-up, as the clinical benefit of a defibrillator attenuated with time.

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“…An adequately powered randomized controlled trial on CRT‐D versus CRT‐P is very unlikely to be performed in the near future and therefore a meta‐analysis is the most adequate method to address this subject. The meta‐analysis by Jiang et al provided valuable insight, but several studies comparing CRT‐D with CRT‐P have been published since its publication …”

Section: Introductionmentioning

confidence: 99%

“…An adequately powered randomized controlled trial on CRT-D versus CRT-P is very unlikely to be performed in the near future and therefore a meta-analysis is the most adequate method to address this subject. The meta-analysis by Jiang et al 20 provided valuable insight, but several studies comparing CRT-D with CRT-P have been published since its publication. 3,[12][13][14]16,18,19,[21][22][23] We aim to perform a systematic review with meta-analysis of the current literature regarding the potential applicability and effectiveness of the ICD in patients receiving CRT.…”

mentioning

confidence: 99%

Importance of Implantable Cardioverter‐Defibrillator Back‐Up in Cardiac Resynchronization Therapy Recipients: A Systematic Review and Meta‐Analysis

Barra

Providência

Tang

et al. 2015

JAHA

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BackgroundIt remains to be determined whether patients receiving cardiac resynchronization therapy (CRT) benefit from the addition of an implantable cardioverter‐defibrillator (ICD).Methods and ResultsWe performed a literature search looking for studies of patients implanted with CRTs. Comparisons were performed between patients receiving CRT‐defibrillator (CRT‐D) versus CRT‐pacemaker (CRT‐P). The primary outcome was all‐cause mortality. Data were pooled using a random‐effects model. The relative risk (RR) and hazard ratio (HR, when available) were used as measurements of treatment effect. Nineteen entries were entitled for inclusion, comprising 12 378 patients (7030 receiving CRT‐D and 5348 receiving CRT‐P) and 29 799 patient‐years of follow‐up. Those receiving CRT‐D were younger, were more often males, had lower NYHA class, lower prevalence of atrial fibrillation, higher prevalence of ischemic heart disease, and were more often on beta‐blockers. Ten studies showed significantly lower mortality rates with the CRT‐D device, while the remaining 9 were neutral. The pooled data of studies revealed that CRT‐D patients had significantly lower mortality rates compared with CRT‐P patients (mortality rates: CRT‐D 16.6% versus CRT‐P 27.1%; RR=0.69, 95% CI 0.62–0.76; P<0.00001). The number needed to treat to prevent one death was 10. The observed I2 values showed moderate heterogeneity among studies (I2=48%). The benefit of CRT‐D was more pronounced in ischemic cardiomyopathy (HR=0.70, 95% CI 0.59–0.83, P<0.001, I2=0%), but a trend for benefit, albeit of lower magnitude, could also be seen in non‐ischemic dilated cardiomyopathy (HR=0.79, 95% CI 0.61–1.02, P=0.07, I2=36%).ConclusionsThe addition of the ICD associates with a reduction in the risk of all‐cause mortality in CRT patients. This seems to be more pronounced in patients with ischemic cardiomyopathy.

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Comparison of CRT and CRT-D in heart failure: Systematic review of controlled trials

Cited by 15 publications

References 23 publications

A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

Cardiac resynchronisation therapy: pacemaker versus internal cardioverter-defibrillator in patients with impaired left ventricular function

Importance of Implantable Cardioverter‐Defibrillator Back‐Up in Cardiac Resynchronization Therapy Recipients: A Systematic Review and Meta‐Analysis

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