Cardiac resynchronization therapy with or without defibrillator in patients with heart failure. Issue 1 (6th September 2021)

• Record Type: Journal Article
• Authors: Schrage, Benedikt; Lund, Lars H; Melin, Michael; Benson, Lina; Uijl, Alicia; Dahlström, Ulf; Braunschweig, Frieder; Linde, Cecilia; Savarese, Gianluigi
• Is Part Of: Europace. Volume 24:Issue 1(2022)
• Page Start: 48
• Page End: 57
• Publication Date: 2021-09-06
• Subjects: Heart failure -- Heart failure with reduced ejection fraction -- Implantable cardioverter-defibrillator -- Cardiac resynchronization therapy -- Primary prevention -- Swedish Heart Failure Registry; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/euab233
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims: Randomized data on the efficacy/safety of cardiac resynchronization therapy with vs. without defibrillator (CRT-D, -P) in heart failure with reduced ejection fraction (HFrEF) are scarce. We aimed to evaluate survival associated with use of CRT-D vs. CRT-P in a contemporary cohort with HFrEF. Methods and results: Patients from Swedish HF Registry treated with CRT-D/CRT-P and fulfilling criteria for primary prevention defibrillator use were included. Logistic regression was used to evaluate predictors of CRT-D non-use. All-cause mortality was compared in CRT-D vs. CRT-P by Cox regression in a 1 : 1 propensity-score-matched cohort. Of 1988 patients with CRT, 1108 (56%) had CRT-D and 880 (44%) CRT-P. Older age, higher ejection fraction (EF), female sex, and the lack of referral to HF nurse-led outpatient clinic were major determinants of CRT-D non-use. After matching, 645 CRT-D patients were compared with 645 with CRT-P. The CRT-D use was associated with lower 1- and 3-year all-cause mortality [hazard ratio (HR):0.76, 95% confidence interval (CI):0.58–0.98; HR: 0.82, 95% CI: 0.68–0.99, respectively]. Results were consistent in all pre-specified subgroups except for CRT-D use being associated with lower 3-year mortality in patients with an EF < 30% but not in those with an EF ≥ 30% (HR: 0.73, 95% CI: 0.59–0.89 and HR: 1.24, 95% CI: 0.83–1.85, respectively; P -interaction = 0.02). Conclusion: In a contemporary HFrEF cohort, CRT-D was associated with lower mortality compared with CRT-P. The CRT-D use was less likely in older patients, females, and in patients not referred to HF nurse-led outpatient clinic. Our findings support the use of CRT-D vs. CRT-P in HFrEF, in particular with severely reduced EF.