Cleland JGF, Bristow MR, Freemantle N, Olshansky B, Gras D, Saxon L, Tavazzi L, Boehmer J, Ghio S, Feldman AM, Daubert JC, deMets D. The Effect of Cardiac Resynchronization without a Defibrillator on Morbidity and Mortality: An Individual-Patient-Data Meta-Analysis of COMPANION and CARE-HF.
Eur J Heart Fail 2022;
24:1080-1090. [PMID:
35490339 PMCID:
PMC9543287 DOI:
10.1002/ejhf.2524]
[Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm.
OBJECTIVES
To identify patient-characteristics that predict the effect, specifically, of CRT-pacemakers (CRT-P) on all-cause mortality or the composite of hospitalisation for heart failure or all-cause mortality.
METHODS
An individual patient-data meta-analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization - Heart Failure (CARE-HF) trials. Only patients assigned to CRT-P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated.
RESULTS
Median age was 67 (59-73) years, most patients were men (70%), 68% had a QRS duration of 150-199 ms and 80% had left bundle branch block (LBBB). Patients assigned to CRT-P had lower rates for all-cause mortality (HR 0.68 (95% CI 0.56 to 0.81; p < 0.0001) and the composite outcome (HR 0.67 (95% CI 0.58 to 0.78; p < 0.0001). No pre-specified characteristic, including sex, aetiology of ventricular dysfunction, QRS duration (within the studied range) or morphology or PR interval significantly influenced the effect of CRT-P on all-cause mortality or the composite outcome. However, CRT-P had a greater effect on the composite outcome for patients with lower body surface area (BSA) and those prescribed beta-blockers.
CONCLUSIONS
CRT-P reduces morbidity and mortality in appropriately selected patients with heart failure. Benefits may be greater in smaller patients and in those receiving beta-blockers. Neither QRS duration nor morphology independently predicted the benefit of CRT-P.
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