Skip to main content
Journal cover image

Comparative Effectiveness of CRT-D Versus Defibrillator Alone in HF Patients With Moderate-to-Severe Chronic Kidney Disease.

Publication ,  Journal Article
Friedman, DJ; Singh, JP; Curtis, JP; Tang, WHW; Bao, H; Spatz, ES; Hernandez, AF; Patel, UD; Al-Khatib, SM
Published in: J Am Coll Cardiol
December 15, 2015

BACKGROUND: Patients with moderate-to-severe chronic kidney disease (CKD) are poorly represented in clinical trials of cardiac resynchronization therapy (CRT). OBJECTIVES: This study sought to assess the real-world comparative effectiveness of CRT with defibrillator (CRT-D) versus implantable cardioverter-defibrillator (ICD) alone in CRT-eligible patients with moderate-to-severe CKD. METHODS: We conducted an inverse probability-weighted analysis of 10,946 CRT-eligible patients (ejection fraction <35%, QRS >120 ms, New York Heart Association functional class III/IV) with stage 3 to 5 CKD in the National Cardiovascular Data Registry (NCDR) ICD Registry, comparing outcomes between patients who received CRT-D (n = 9,525) versus ICD only (n = 1,421). Outcomes were obtained via Medicare claims and censored at 3 years. The primary endpoint of heart failure (HF) hospitalization or death and the secondary endpoint of death were assessed with Cox proportional hazards models. HF hospitalization, device explant, and progression to end-stage renal disease were assessed using Fine-Gray models. RESULTS: After risk adjustment, CRT-D use was associated with a reduction in HF hospitalization or death (hazard ratio [HR]: 0.84; 95% confidence interval [CI]: 0.78 to 0.91; p < 0.0001), death (HR: 0.85; 95% CI: 0.77 to 0.93; p < 0.0004), and HF hospitalization alone (subdistribution HR: 0.84; 95% CI: 0.76 to 0.93; p < 0.009). Subgroup analyses suggested that CRT was associated with a reduced risk of HF hospitalization and death across CKD classes. The incidence of in-hospital, short-term, and mid-term device-related complications did not vary across CKD stages. CONCLUSIONS: In a nationally representative population of HF and CRT-eligible patients, use of CRT-D was associated with a significantly lower risk of the composite endpoint of HF hospitalization or death among patients with moderate-to-severe CKD in the setting of acceptable complication rates.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 15, 2015

Volume

66

Issue

23

Start / End Page

2618 / 2629

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Severity of Illness Index
  • Renal Insufficiency, Chronic
  • Proportional Hazards Models
  • Medicare
  • Male
  • Humans
  • Hospitalization
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Friedman, D. J., Singh, J. P., Curtis, J. P., Tang, W. H. W., Bao, H., Spatz, E. S., … Al-Khatib, S. M. (2015). Comparative Effectiveness of CRT-D Versus Defibrillator Alone in HF Patients With Moderate-to-Severe Chronic Kidney Disease. J Am Coll Cardiol, 66(23), 2618–2629. https://doi.org/10.1016/j.jacc.2015.09.097
Friedman, Daniel J., Jagmeet P. Singh, Jeptha P. Curtis, WH Wilson Tang, Haikun Bao, Erica S. Spatz, Adrian F. Hernandez, Uptal D. Patel, and Sana M. Al-Khatib. “Comparative Effectiveness of CRT-D Versus Defibrillator Alone in HF Patients With Moderate-to-Severe Chronic Kidney Disease.J Am Coll Cardiol 66, no. 23 (December 15, 2015): 2618–29. https://doi.org/10.1016/j.jacc.2015.09.097.
Friedman DJ, Singh JP, Curtis JP, Tang WHW, Bao H, Spatz ES, et al. Comparative Effectiveness of CRT-D Versus Defibrillator Alone in HF Patients With Moderate-to-Severe Chronic Kidney Disease. J Am Coll Cardiol. 2015 Dec 15;66(23):2618–29.
Friedman, Daniel J., et al. “Comparative Effectiveness of CRT-D Versus Defibrillator Alone in HF Patients With Moderate-to-Severe Chronic Kidney Disease.J Am Coll Cardiol, vol. 66, no. 23, Dec. 2015, pp. 2618–29. Pubmed, doi:10.1016/j.jacc.2015.09.097.
Friedman DJ, Singh JP, Curtis JP, Tang WHW, Bao H, Spatz ES, Hernandez AF, Patel UD, Al-Khatib SM. Comparative Effectiveness of CRT-D Versus Defibrillator Alone in HF Patients With Moderate-to-Severe Chronic Kidney Disease. J Am Coll Cardiol. 2015 Dec 15;66(23):2618–2629.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 15, 2015

Volume

66

Issue

23

Start / End Page

2618 / 2629

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Survival Analysis
  • Severity of Illness Index
  • Renal Insufficiency, Chronic
  • Proportional Hazards Models
  • Medicare
  • Male
  • Humans
  • Hospitalization