1. Cardiac resynchronization therapy with or without defibrillator in patients with heart failure
- Author
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Lars H. Lund, Michael Melin, Alicia Uijl, Lina Benson, Gianluigi Savarese, Cecilia Linde, B. Schrage, Ulf Dahlström, and Frieder Braunschweig
- Subjects
Male ,medicine.medical_specialty ,genetic structures ,medicine.medical_treatment ,Cardiac resynchronization therapy ,Swedish Heart Failure Registry ,Implantable cardioverter-defibrillator ,Ventricular Dysfunction, Left ,Pacing and Cardiac Resynchronization Therapy ,Risk Factors ,Physiology (medical) ,Internal medicine ,Medicine ,Outpatient clinic ,Humans ,AcademicSubjects/MED00200 ,Cardiac and Cardiovascular Systems ,cardiovascular diseases ,Aged ,Heart Failure ,Ejection fraction ,Primary prevention ,Kardiologi ,business.industry ,Proportional hazards model ,Hazard ratio ,Stroke Volume ,medicine.disease ,Heart failure with reduced ejection fraction ,equipment and supplies ,Defibrillators, Implantable ,Treatment Outcome ,Heart failure ,Cohort ,Cinical Research ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,circulatory and respiratory physiology - Abstract
Aims Randomized data on the efficacy/safety of cardiac resynchronization therapy with vs. without defibrillator (CRT-D,-P) in heart failure with reduced ejection fraction (HFrEF) are scarce. We aimed to evaluate survival associated with use of CRT-D vs. CRT-P in a contemporary cohort with HFrEF. Methods and results Patients from Swedish HF Registry treated with CRT-D/CRT-P and fulfilling criteria for primary prevention defibrillator use were included. Logistic regression was used to evaluate predictors of CRT-D non-use. All-cause mortality was compared in CRT-D vs. CRT-P by Cox regression in a 1 : 1 propensity-score-matched cohort. Of 1988 patients with CRT, 1108 (56%) had CRT-D and 880 (44%) CRT-P. Older age, higher ejection fraction (EF), female sex, and the lack of referral to HF nurse-led outpatient clinic were major determinants of CRT-D non-use. After matching, 645 CRT-D patients were compared with 645 with CRT-P. The CRT-D use was associated with lower 1- and 3-year all-cause mortality [hazard ratio (HR):0.76, 95% confidence interval (CI):0.58–0.98; HR: 0.82, 95% CI: 0.68–0.99, respectively]. Results were consistent in all pre-specified subgroups except for CRT-D use being associated with lower 3-year mortality in patients with an EF Conclusion In a contemporary HFrEF cohort, CRT-D was associated with lower mortality compared with CRT-P. The CRT-D use was less likely in older patients, females, and in patients not referred to HF nurse-led outpatient clinic. Our findings support the use of CRT-D vs. CRT-P in HFrEF, in particular with severely reduced EF.
- Published
- 2022