Impact of Cardiac Resynchronization Therapy on Hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial
Background—This study reports the impact of cardiac resynchronization therapy (CRT) on hospitalizations in patients randomized to implantable defibrillator (ICD) or ICD-CRT in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT).
Methods and Results—Hospitalization rates and length of hospital stay were compared between the two groups. At 18 months follow-up, the number of patients hospitalized for any cause was similar in the ICD (n=351, 38.8%) and ICD-CRT groups (n=331, 30.0%). The number of patients hospitalized for heart failure (HF) was significantly lower in the ICD-CRT (n=101, 11.3%) vs the ICD group (n=141, 15.6%, p=0.003). The number of patients hospitalized for a device-related indication was similar in the ICD-CRT group (n=147, 16.4%) vs the ICD group (n=126, 13.9%, p = 0.148). The total number of hospitalizations for any cause (n=1448 vs n=1553, p=0.042), any cardiovascular cause (n=667 vs n=790, p=0.017) and any HF cause (n=385 vs n=505, p<0.0001) was significantly lower in ICD-CRT group vs the ICD group whereas the number of hospitalizations for device-related causes was significantly higher in the ICD-CRT group vs the ICD group (246 vs 159, p<0.001) Although, the reduction in hospitalizations for HF in the CRT-ICD group was offset by an increased number of hospitalizations for device-related indications, the length of hospital stay for any cause was significantly lower in the ICD-CRT group (8.83±13.30 days) vs the ICD group (9.59±14.40 days, p=0.005) .
Conclusions—ICD-CRT therapy significantly reduces hospitalizations and total days in hospital in patients with NYHA II/III HF compared to ICD therapy despite increased admissions for device-related indications.
Clinical Trial Registration Information—www.clinicaltrials.gov Identifier: NCT00251251.
- Received December 6, 2012.
- Revision received February 19, 2014.
- Accepted March 3, 2014.