Abstract 17532: Clinical Effectiveness of Cardiac Resynchronization Therapy Compared to Medical Therapy Alone Among Patients With Heart Failure: An Analysis of the ICD and ADHERE National Registries
Background: CRT-D reduces morbidity and mortality among selected patients with HF in clinical trials. The effectiveness of this therapy in clinical practice has not been well-studied.
Methods: The cohort included 4,888 HF patients without CRT-D who were hospitalized between January 2002 and March 2006 from the ADHERE Registry, and 4,471 patients from the National Cardiovascular Data Registry’s ICD Registry™ hospitalized primarily for HF and who received CRT-D between April 2006 and December 2009. Both registries were linked with Medicare claims to evaluate longitudinal outcomes. We included patients from the ICD Registry who had LVEF ≤ 35%, QRS duration ≥ 120 msec, and were admitted for HF. We used Cox proportional hazards models to compare outcomes with and without CRT-D after adjusting for demographics and clinical factors.
Results: Patients who received CRT-D were younger, more likely to be male and white, and had more comorbidities. After multivariable adjustment, CRT-D was associated with lower 3-yr risk of death (HR 0.52; 95% CI 0.48-0.56; p<0.0001) (Figure) and cardiovascular readmission (0.60; 0.56-0.64; p<0.0001). The association of CRT-D therapy with mortality did not vary significantly among subgroups defined by age, sex, race, QRS duration, and optimal medical therapy.
Conclusions: CRT-D was associated with a lower risk of mortality and cardiovascular readmission compared to medical therapy among patients with HF in practice, including those underrepresented in clinical trials.
- © 2013 by American Heart Association, Inc.