Long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation: impact of the aetiology of cardiomyopathy

Leyva, Francisco; Zegard, Abbasin; Umar, Fraz; Taylor, Robin J.; Acquaye, E.; Gubran, Christopher; Chalil, Shajil; Patel, Kiran; Panting, Jonathan; Marshall, Howard; Qiu, Tianyi

doi:10.1093/europace/eux357

Cited by 34 publications

(30 citation statements)

References 19 publications

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“…In the present study, there was no device-by-sex or device-by-aetiology interaction with regards to mortality benefit, although these interactions have been recently proposed (5,7,26). There are several plausible explanations for this.…”

Section: Discussioncontrasting

confidence: 51%

Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients

Barra

Duehmke

Providência

et al. 2019

European Heart Journal

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Aims The very long-term outcome of patients who survive the first few years after receiving cardiac resynchronization therapy (CRT) has not been well described thus far. We aimed to provide long-term outcomes, especially with regard to the occurrence of sudden cardiac death (SCD), in CRT patients without (CRT-P) and with defibrillator (CRT-D). Methods and results A total of 1775 patients, with ischaemic or non-ischaemic dilated cardiomyopathy, who were alive 5 years after CRT implantation, were enrolled in this multicentre European observational cohort study. Overall long-term mortality rates and specific causes of death were assessed, with a focus on late SCD. Over a mean follow-up of 30 months (interquartile range 10–42 months) beyond the first 5 years, we observed 473 deaths. The annual age-standardized mortality rates of CRT-D and CRT-P patients were 40.4 [95% confidence interval (CI) 35.3–45.5] and 97.2 (95% CI 85.5–109.9) per 1000 patient-years, respectively. The adjusted hazard ratio (HR) for all-cause mortality was 0.99 (95% CI 0.79–1.22). Twenty-nine patients in total died of late SCD (14 with CRT-P, 15 with CRT-D), corresponding to 6.1% of all causes of death in both device groups. Specific annual SCD rates were 8.5 and 5.8 per 1000 patient-years in CRT-P and CRT-D patients, respectively, with no significant difference between groups (adjusted HR 1.0, 95% CI 0.45–2.44). Death due to progressive heart failure represented the principal cause of death (42.8% in CRT-P patients and 52.6% among CRT-D recipients), whereas approximately one-third of deaths in both device groups were due to non-cardiovascular death. Conclusion In this first description of very long-term outcomes among CRT recipients, progressive heart failure death still represented the most frequent cause of death in patients surviving the first 5 years after CRT implant. In contrast, SCD represents a very low proportion of late mortality irrespective of the presence of a defibrillator.

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Section: Discussioncontrasting

confidence: 51%

Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients

Barra

Duehmke

Providência

et al. 2019

European Heart Journal

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“…Notwithstanding, several meta-analyses involving higher patient numbers have shown a benefit in total mortality from ICDs in patients with NICM 6 . In an observational study of 1500 patients, we found that CRT-D was associated with a lower total mortality (HR 0.62) in patients with ischaemic cardiomyopathy (ICM) after propensity matching 7 . In contrast, total mortality after CRT-D and CRT-P was similar in patients with NICM.…”

Section: Discussionmentioning

confidence: 63%

Survival after cardiac resynchronization therapy: results from 50 084 implantations

et al. 2018

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Aims Randomized controlled trials have shown that cardiac resynchronization therapy (CRT) prolongs survival in patients with heart failure. No studies have explored survival after CRT in relation to individuals in the general population (relative survival, RS). We sought to determine observed and RS after CRT in a nationwide cohort undergoing CRT. Methods and results A national administrative database was used to quantify observed mortality for patients undergoing CRT. Relative survival (RS) was quantified using life tables. In 50 084 patients [age 72.1 ± 11.6 years (mean ± standard deviation)] undergoing CRT with (CRT-D) ( n = 25 273) or without (CRT-P) defibrillation ( n = 24 811) over 8.8 years (median follow-up 2.7 years, interquartile range 1.3–4.8), expected survival decreased with age. Device type, male sex, ischaemic heart disease, diabetes, and chronic kidney disease predicted excess mortality. In multivariate analyses, excess mortality (analogue of RS) was lower after CRT-D than after CRT-P in all patients [adjusted hazard ratio (aHR) 0.80, 95% confidence interval (CI) 0.76–0.84] as well as in subgroups with (aHR 0.79, 95% CI 0.74–0.84) or without (aHR 0.82, 95% CI 0.74–0.91) ischaemic heart disease. A Charlson Comorbidity Index (CCI) ≥3 portended a higher excess mortality (aHR 3.04, 95% CI 2.76–3.34). Relative survival was higher in 2015–2017 than in 2009–2011 (aHR 0.64, 95% CI 0.59–0.69). Conclusion Reference RS data after CRT is presented. Sex, ischaemic heart disease, diabetes, chronic kidney disease, and CCI were major determinants of RS after CRT. CRT-D was associated with a higher RS than CRT-P in patients with or without ischaemic heart disease. Relative survival after CRT improved from 2009 to 2017.

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“…2,8,9 Several observational studies could not identify symptomatic heart failure patients who benefit more from CTR-D than CRT-P, as there were significant demographic and morbid differences between the two patient groups. 14,18,19 Despite this, the superiority of CRT-D to CRT-P was reported in HFrEF patients with ischemic cardiomyopathy, [20][21][22][23] those with nonischemic cardiomyopathy having left ventricular midwall fibrosis 24 and those with the Goldenberg (MADIT) risk scores 0-2. 25 More recently, CRT-D…”

Section: Discussionmentioning

confidence: 99%

Trends in the use of implantable cardioverter‐defibrillator and cardiac resynchronization therapy device in advancing age: Analysis of the Japan cardiac device treatment registry database

Yokoshiki

Shimizu²,

Mitsuhashi

et al. 2020

Journal of Arrhythmia

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Background Trends of de novo implantation of cardiac implantable electronic devices (CIEDs) including implantable cardioverter‐defibrillator (ICD) and cardiac resynchronization therapy with a defibrillator (CRT‐D) or pacemaker (CRT‐P) in advancing age are unknown. Methods Analysis of data from the Japan cardiac device treatment registry (JCDTR) with an implantation date between January 2006 and December 2016 was performed focusing on advancing age of ≧75 years. Results The cohort included 17 564 ICD, 9470 CRT‐D and 1087 CRT‐P recipients for de novo implantation. The rate of patients ≧75 years of age increased from 17.1% to 20.5% in ICD implantation (P = .052), from 19.7% to 30.0% in CRT‐D implantation (P < .0001), and from 40.0% to 64.0% in CRT‐P implantation (P = .17). There was an apparent increase in the percentage of nonischemic patients aged ≧75 years receiving ICD (10.9% in 2006 to 16.4% in 2016, P = .0008) and CRT‐D (17.1% in 2006 to 27.8% in 2016, P = .0001). The implantation for primary prevention ICD (P = .059) and CRT‐D (P = .012) was also associated with a temporal increase in the percentage of patients aged ≧75 years. Conclusions Proportion of patients ≧75 years of age for de novo CIED implantation gradually increased from 2006 to 2016, presumably because of the growing number of nonischemic cardiomyopathy and heart failure patients requiring primary prevention of sudden cardiac death.

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Long-term clinical outcomes of cardiac resynchronization therapy with or without defibrillation: impact of the aetiology of cardiomyopathy

Cited by 34 publications

References 19 publications

Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients

Very long-term survival and late sudden cardiac death in cardiac resynchronization therapy patients

Survival after cardiac resynchronization therapy: results from 50 084 implantations

Trends in the use of implantable cardioverter‐defibrillator and cardiac resynchronization therapy device in advancing age: Analysis of the Japan cardiac device treatment registry database

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