The European CRT Survey: 1 year (9–15 months) follow‐up results

Abstract

Aims The European CRT Survey is a joint initiative of the Heart Failure Association (HFA) and the European Heart Rhythm Association (EHRA) of the European Society of Cardiology evaluating the contemporary implantation practice of cardiac resynchronization therapy (CRT) in Europe. Methods and results Patients who had a successful CRT implantation were enrolled from 141 centres in 13 countries between November 2008 and June 2009. Baseline demographics, clinical and implantation data were collected, with a follow‐up of ∼1 year (9–15 months). The current report describes clinical outcomes including symptom severity, cardiovascular (CV) hospitalization, and survival. A total of 2438 patients were enrolled, and follow‐up data were acquired from 2111 patients (87%). The population included important groups of patients poorly represented in randomized controlled trials, including very elderly patients and those with prior device implantation, atrial fibrillation, and/or QRS duration <120 ms. Investigators reported substantial improvement in New York Heart Association (NYHA) functional class at follow‐up. Patient self‐assessment indicated that 81% of the patients felt improved, 16% reported no change, and 4% reported deterioration. During follow‐up, 207 (10%) patients died, 346 (16%) had a CV hospitalization, and 501 (24%) died or had CV hospitalization. Worse NYHA functional class, atrial fibrillation, ischaemic aetiology, and device type (CRT‐P, i.e. CRT alone) were associated with poorer survival. Women had a better outcome, as did patients who had a CRT‐D (with an implantable cardioverter defibrillator function) device. Conclusions Outcomes including death and hospitalization in this European CRT survey were consistent with results from clinical trials of CRT. At 1 year follow‐up, most patients who received a CRT device considered their symptoms improved compared with their pre‐implant assessment. Although prospective, this is an observational study of successful CRT implantations, and outcomes in subgroup analyses must be interpreted with appropriate conservatism. Clinical study no: NCT 01185392

Implantable Defibrillators Improve Survival in Patients With Mildly Symptomatic Heart Failure Receiving Cardiac Resynchronization Therapy

“…The European CRT Survey was a prospective, multinational, observational study. 20 This study showed that CRT-P was independently associated with higher mortality, as well as atrial fibrillation, and advanced HF, 2 comorbidities excluded in REVERSE. There were trends for improved survival in women and with longer QRS duration, similar to the present study.…”

Sex-specific mortality differences in heart failure patients with ischemia receiving cardiac resynchronization therapy

“…Begg test showed no evidence of publication bias (P = 0.08) rather than Egger test (P = 0.01), the funnel plot was shown in S1A Fig. A total of 11 studies [8, 13–15, 20, 24, 30, 38, 49, 51, 64] reported sex-related differences in relation to heart failure hospitalization or heart failure; the HR for significant heterogeneity, which was calculated using random-effect models, was 0.58 (95% CI, 0.46–0.74, P < 0.0001, Fig 3) (I 2 = 62%; P = 0.003). No evidence of publication bias was found in Begg test (P = 0.76) and Egger test (P = 0.68), and the funnel plot was shown in S1B Fig.…”

“…However, patients with no ischemic cardiomyopathy (NICM) have been shown to exhibit better outcomes and greater reverse remodeling compared to those with ICM [68]. We further mined the collected data and analyzed the baselines associated with patients exhibiting ischemic causes and found: (1) ischemia is more common in males than in females (83.23% vs. 16.77%) [9–14, 19, 27, 38, 49], (2) the prevalence of female patients was similar in lower and higher rate ischemic cause subgroups (23.34% vs. 22.82%), (3) Patients with ischemia exhibited a 47% increase in the rate of all-cause mortality (S2 Fig). These findings suggest that male patients have a higher risk of ischemia, which is a certain factor in relation to higher mortality.…”

Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy: Therapeutic Options

“…In a current report of the European CRT Survey, 6 patients with AF have a poorer 1-year survival than those with sinus rhythm (86% vs. 91%, p = 0.0038). Wilton et al 7 performed a meta-analysis of 23 studies, which have compared the outcomes of CRT patients with (n = 1912) and patients without (n = 5583) AF.…”