Survival after cardiac resynchronization therapy: results from 50 084 implantations

Abstract

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.

Implantable cardioverter defibrillator and cardiac resynchronization therapy use in New Zealand (ANZACS‐QI 33)

“…Female gender has been associated with a “super‐response” to CRT in previous studies, thus women are also more likely to be offered a CRT‐P in NZ . This trend is consistent with several contemporary international registries and studies . Of note, those studies have shown very similar LV systolic function between the CRT‐P and CRT‐D cohorts, with CRT‐P having a longer mean QRS duration.…”

Prognostication of Poor Survival After Cardiac Resynchronization Therapy

“…The most recent clinical trials led by Francisco [5] and Jian-Shu [34] found that ischemic cardiomyopathy is a significant predictor related to worse survival after the CRT. The underlying mechanism of this phenomenon could be explained by CRT correcting conduction disorders caused by delayed activation regions of the left ventricular wall.…”

“…The main factors associated with HF prognosis are male gender; age; elevated resting heart rate; hospital admissions and emergency department visits the previous year; natriuretic peptides; troponin T and I levels; and comorbidities: diabetes mellitus, chronic kidney disease, dementia, cirrhosis, atrial fibrillation, cardiac conduction disorders, ischemic origin of HF, hypertensive heart disease, etc. [3][4][5].…”

Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care

“…Comorbidities are frequent in heart failure and affect the delivery and effect of heart failure therapy, functional status, and clinical outcomes 77–80 . Due to this competing risk patients with comorbidities derive less benefit from an ICD (see next section).…”