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Taborsky M, Skala T, Aiglova R, Fedorco M, Kautzner J, Jandik T, Vancura V, Linhart A, Valek M, Novak M, Kala P, Polasek R, Roubicek T, Schee A, Hindricks G, Dagres N, Hatalaj R, Jarkovsky J. Cardiac Resynchronization and Defibrillator Therapy (CRT-D) or CRT Alone (CRT-P) in patients with dilated cardiomyopathy and heart failure without late gadolinium enhancement (LGE) cardiac magnetic resonance imaging (CMRI) high-risk markers - CRT-REALITY study - Study design and rationale. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:173-179. [PMID: 33724264 DOI: 10.5507/bp.2021.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/05/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Primary preventive implantation of implantable defibrillator (ICD) is according to current guidelines indicated in patients with heart failure NYHA (New York Heart Association) class II/III and LVEF <35%. Thanks to advances in heart failure pharmacotherapy, a decrease in mortality could render a benefit of ICD insufficient to justify its implantation in some patients. METHODS Study design: multicenter, prospective, randomized, controlled trial evaluating the benefit of implantation of Cardiac Resynchronization and Defibrillator Therapy (CRT-D) or CRT Alone (CRT-P) in non-ischemic patients with reduced left ventricle ejection fraction (LVEF) and optimal pharmacotherapy without significant mid-wall myocardial fibrosis detected by cardiac magnetic resonance (CMR). The primary end-point: Re-hospitalization for heart failure, ventricular tachycardia, major adverse cardiac events (MACE). The secondary end-points: Sudden cardiac death, cardiovascular death, resuscitated cardiac arrest or sustained ventricular tachycardia, device-related complications, and change in quality of life. Course of the study: After a pharmacotherapy is optimized and significant mid-wall myocardial fibrosis excluded, patients will be randomized 1:1 to CRT-P or CRT-D implantation. DISCUSSION If our hypothesis is confirmed, this could provide evidence for the management of these patients with a significant impact on common daily praxis and health care expenditures. TRIAL REGISTRATION ClinicalTrials.gov, NCT04139460.
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Affiliation(s)
- Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Tomas Skala
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Renata Aiglova
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Marian Fedorco
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Josef Kautzner
- Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Tomas Jandik
- Department of Cardiology, University Hospital Pilzen, Czech Republic
| | - Vlastimil Vancura
- Department of Cardiology, University Hospital Pilzen, Czech Republic
| | - Ales Linhart
- The Internal Clinic of Cardiology and Angiology of the First Faculty of Medicine and General Teaching Hospital, Czech Republic
| | - Martin Valek
- The Internal Clinic of Cardiology and Angiology of the First Faculty of Medicine and General Teaching Hospital, Czech Republic
| | | | - Petr Kala
- University Hospital Brno, Czech Republic
| | | | | | - Alexandr Schee
- Private Cardiovascular Center Karlovy Vary Kardio KV L.T.D., Czech Republic
| | | | | | - Robert Hatalaj
- Institute for Biostatistics and Analyses of Faculty of Medicine Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute for Biostatistics and Analyses of Faculty of Medicine Brno, Czech Republic
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Boriani G, Cimaglia P, Biffi M, Martignani C, Ziacchi M, Valzania C, Diemberger I. Cost-effectiveness of implantable cardioverter-defibrillator in today's world. Indian Heart J 2013; 66 Suppl 1:S101-4. [PMID: 24568820 DOI: 10.1016/j.ihj.2013.12.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/07/2013] [Indexed: 11/18/2022] Open
Abstract
The implantable cardioverter-defibrillator (ICD) is an example of an effective intervention with high up-front costs and delayed benefits. It has become a proven and well-accepted therapy not only for secondary but also for primary prevention of sudden cardiac death in patients with ischemic and non-ischemic heart disease. In recent years, the international guidelines have extended the indications to the prophylactic ICD, increasing the number of eligible patients and, together, the financial challenges of a widespread implementation. In this article, we review the available economic tools that can help address the ICD cost issue. We think that the awareness of such knowledge may facilitate dialogues between physicians, administrators and policy-makers, and help foster rational decision making.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital Sant' Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy.
| | - Paolo Cimaglia
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital Sant' Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital Sant' Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
| | - Cristian Martignani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital Sant' Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital Sant' Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
| | - Cinzia Valzania
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital Sant' Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
| | - Igor Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University Hospital Sant' Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy
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Goldberger JJ, Buxton AE, Cain M, Costantini O, Exner DV, Knight BP, Lloyd-Jones D, Kadish AH, Lee B, Moss A, Myerburg R, Olgin J, Passman R, Rosenbaum D, Stevenson W, Zareba W, Zipes DP. Risk Stratification for Arrhythmic Sudden Cardiac Death. Circulation 2011; 123:2423-30. [DOI: 10.1161/circulationaha.110.959734] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jeffrey J. Goldberger
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Alfred E. Buxton
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Michael Cain
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Otto Costantini
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Derek V. Exner
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Bradley P. Knight
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Donald Lloyd-Jones
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Alan H. Kadish
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Byron Lee
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Arthur Moss
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Robert Myerburg
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Jeffrey Olgin
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Rod Passman
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - David Rosenbaum
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - William Stevenson
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Wojciech Zareba
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
| | - Douglas P. Zipes
- From the Path to Improved Risk Stratification/Northwestern University, Chicago, IL (J.J.G.); Brown University, Providence, RI (A.E.B.); State University of New York at Buffalo (M.C.); MetroHealth Campus, Case Western Reserve University, Cleveland, OH (O.C., D.R.); Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada (D.V.E.); Northwestern University, Chicago, IL (B.P.K., D.L.-J., A.H.K., R.P.); University of California at San Francisco (B.L., J.O.); University
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