Abstract 1600: Cardiac Resynchronization Therapy Reduces the Risk of Hospitalizations in Patients with Advanced Heart Failure - Results From the COMPANION Trial
Background: In the COMPANION Trial 1520 patients with advanced heart failure were assigned in 1:2:2 ratio to optimal pharmacologic therapy (OPT) or OPT + cardiac resynchronization therapy (CRT-P) or CRT with defibrillator (CRT-D). Use of CRT-P and CRT-D was associated with significant reduction in combined risk of death or all-cause hospitalizations. Because mortality was also significantly reduced, an assessment of the true reduction in hospitalization rates must consider the competing risk of death and varying follow-up time.
Methods and Results: To overcome this difficulty we used a nonparametric test of right-censored recurrent events (Ghosh and Lin 2000), to compare treatment groups. The tests are robust as they account for dependence between hospitalizations and death as a competing risk and do not rely on distributional assumptions of the dependence between hospitalizations. An end-point committee adjudicated all-cause, cardiac and HF hospitalization rates are shown below. As compared to OPT, CRT-P and CRT-D were associated with a 21% and 25% reduction in all-cause, 34% and 37% reduction in cardiac and 44% and 41% reduction in HF hospitalizations. Non-cardiac hospitalization rates were not different between the groups. Similar reductions were seen in hospitalization days per patient year.
Conclusions: CRT with or without a defibrillator in advanced heart failure patients is associated with marked reductions in all-cause, cardiac, and heart failure hospitalization rates in an analysis that accounts for the competing risk of mortality and unequal follow-up time.