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Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study.

Publication ,  Journal Article
Masoudi, FA; Mi, X; Curtis, LH; Peterson, PN; Curtis, JP; Fonarow, GC; Hammill, SC; Heidenreich, PA; Al-Khatib, SM; Piccini, JP; Qualls, LG ...
Published in: Ann Intern Med
May 6, 2014

BACKGROUND: Trials comparing implantable cardioverter-defibrillator (ICD) therapy with cardiac resynchronization therapy with a defibrillator (CRT-D) are limited to selected patients treated at centers with extensive experience. OBJECTIVE: To compare outcomes after CRT-D versus ICD therapy in contemporary practice. DESIGN: Retrospective cohort study using the National Cardiovascular Data Registry's ICD Registry linked with Medicare claims. SETTING: 780 U.S. hospitals implanting both CRT-D and ICD devices. PATIENTS: 7090 propensity-matched patients older than 65 years with reduced left ventricular ejection fraction (<0.35) and prolonged QRS duration on electrocardiography (≥120 ms) having CRT-D or ICD implantation between 1 April 2006 and 31 December 2009. MEASUREMENTS: Risks for death, readmission, and device-related complications over 3 years. RESULTS: Compared with ICD therapy, CRT-D was associated with lower risks for mortality (cumulative incidence, 25.7% vs. 29.8%; adjusted hazard ratio [HR], 0.82 [99% CI, 0.73 to 0.93]), all-cause readmission (cumulative incidence, 68.6% vs. 72.8%; adjusted HR, 0.86 [CI, 0.81 to 0.93]), cardiovascular readmission (cumulative incidence, 45.0% vs. 52.4%; adjusted HR, 0.80 [CI, 0.73 to 0.88]), and heart failure readmission (cumulative incidence, 24.3% vs. 29.4%; adjusted HR, 0.78 [CI, 0.69 to 0.88]). It was also associated with greater risks for device-related infection (cumulative incidence, 1.9% vs. 1.0%; adjusted HR, 1.90 [CI, 1.07 to 3.37]). The lower risks for heart failure readmission associated with CRT-D compared with ICD therapy were most pronounced among patients with left bundle branch block or a QRS duration at least 150 ms and in women. LIMITATIONS: Patients were not randomly assigned to treatment groups, and few patients could be propensity-matched. The findings may not extend to younger patients or those outside of fee-for-service Medicare. CONCLUSION: In older patients with reduced left ventricular ejection fraction and prolonged QRS duration, CRT-D was associated with lower risks for death and readmission than ICD therapy alone. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

May 6, 2014

Volume

160

Issue

9

Start / End Page

603 / 611

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Stroke Volume
  • Risk Factors
  • Retrospective Studies
  • Propensity Score
  • Patient Readmission
  • Infections
  • Humans
  • Heart Failure
 

Citation

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Masoudi, F. A., Mi, X., Curtis, L. H., Peterson, P. N., Curtis, J. P., Fonarow, G. C., … Hernandez, A. F. (2014). Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study. Ann Intern Med, 160(9), 603–611. https://doi.org/10.7326/M13-1879
Masoudi, Frederick A., Xiaojuan Mi, Lesley H. Curtis, Pamela N. Peterson, Jeptha P. Curtis, Gregg C. Fonarow, Stephen C. Hammill, et al. “Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study.Ann Intern Med 160, no. 9 (May 6, 2014): 603–11. https://doi.org/10.7326/M13-1879.
Masoudi FA, Mi X, Curtis LH, Peterson PN, Curtis JP, Fonarow GC, et al. Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study. Ann Intern Med. 2014 May 6;160(9):603–11.
Masoudi, Frederick A., et al. “Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study.Ann Intern Med, vol. 160, no. 9, May 2014, pp. 603–11. Pubmed, doi:10.7326/M13-1879.
Masoudi FA, Mi X, Curtis LH, Peterson PN, Curtis JP, Fonarow GC, Hammill SC, Heidenreich PA, Al-Khatib SM, Piccini JP, Qualls LG, Hernandez AF. Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study. Ann Intern Med. 2014 May 6;160(9):603–611.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

May 6, 2014

Volume

160

Issue

9

Start / End Page

603 / 611

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Stroke Volume
  • Risk Factors
  • Retrospective Studies
  • Propensity Score
  • Patient Readmission
  • Infections
  • Humans
  • Heart Failure