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QRS duration, bundle-branch block morphology, and outcomes among older patients with heart failure receiving cardiac resynchronization therapy.

Publication ,  Journal Article
Peterson, PN; Greiner, MA; Qualls, LG; Al-Khatib, SM; Curtis, JP; Fonarow, GC; Hammill, SC; Heidenreich, PA; Hammill, BG; Piccini, JP ...
Published in: JAMA
August 14, 2013

IMPORTANCE: The benefits of cardiac resynchronization therapy (CRT) in clinical trials were greater among patients with left bundle-branch block (LBBB) or longer QRS duration. OBJECTIVE: To measure associations between QRS duration and morphology and outcomes among patients receiving a CRT defibrillator (CRT-D) in clinical practice. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of Medicare beneficiaries in the National Cardiovascular Data Registry's ICD Registry between 2006 and 2009 who underwent CRT-D implantation. Patients were stratified according to whether they were admitted for CRT-D implantation or for another reason, then categorized as having either LBBB or no LBBB and QRS duration of either 150 ms or greater or 120 to 149 ms. MAIN OUTCOMES AND MEASURES: All-cause mortality; all-cause, cardiovascular, and heart failure readmission; and complications. Patients underwent follow-up for up to 3 years, with follow-up through December 2011. RESULTS: Among 24 169 patients admitted for CRT-D implantation, 1-year and 3-year mortality rates were 9.2% and 25.9%, respectively. All-cause readmission rates were 10.2% at 30 days and 43.3% at 1 year. Both the unadjusted rate and adjusted risk of 3-year mortality were lowest among patients with LBBB and QRS duration of 150 ms or greater (20.9%), compared with LBBB and QRS duration of 120 to 149 ms (26.5%; adjusted hazard ratio [HR], 1.30 [99% CI, 1.18-1.42]), no LBBB and QRS duration of 150 ms or greater (30.7%; HR, 1.34 [99% CI, 1.20-1.49]), and no LBBB and QRS duration of 120 to 149 ms (32.3%; HR, 1.52 [99% CI, 1.38-1.67]). The unadjusted rate and adjusted risk of 1-year all-cause readmission were also lowest among patients with LBBB and QRS duration of 150 ms or greater (38.6%), compared with LBBB and QRS duration of 120 to 149 ms (44.8%; adjusted HR, 1.18 [99% CI, 1.10-1.26]), no LBBB and QRS duration of 150 ms or greater (45.7%; HR, 1.16 [99% CI, 1.08-1.26]), and no LBBB and QRS duration of 120 to 149 ms (49.6%; HR, 1.31 [99% CI, 1.23-1.40]). There were no observed associations with complications. CONCLUSIONS AND RELEVANCE: Among fee-for-service Medicare beneficiaries undergoing CRT-D implantation in clinical practice, LBBB and QRS duration of 150 ms or greater, compared with LBBB and QRS duration less than 150 ms or no LBBB regardless of QRS duration, was associated with lower risk of all-cause mortality and of all-cause, cardiovascular, and heart failure readmissions.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

August 14, 2013

Volume

310

Issue

6

Start / End Page

617 / 626

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk
  • Retrospective Studies
  • Patient Readmission
  • Medicare
  • Male
  • Humans
  • Heart Failure
  • General & Internal Medicine
 

Citation

APA
Chicago
ICMJE
MLA
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Peterson, P. N., Greiner, M. A., Qualls, L. G., Al-Khatib, S. M., Curtis, J. P., Fonarow, G. C., … Masoudi, F. A. (2013). QRS duration, bundle-branch block morphology, and outcomes among older patients with heart failure receiving cardiac resynchronization therapy. JAMA, 310(6), 617–626. https://doi.org/10.1001/jama.2013.8641
Peterson, Pamela N., Melissa A. Greiner, Laura G. Qualls, Sana M. Al-Khatib, Jeptha P. Curtis, Gregg C. Fonarow, Stephen C. Hammill, et al. “QRS duration, bundle-branch block morphology, and outcomes among older patients with heart failure receiving cardiac resynchronization therapy.JAMA 310, no. 6 (August 14, 2013): 617–26. https://doi.org/10.1001/jama.2013.8641.
Peterson PN, Greiner MA, Qualls LG, Al-Khatib SM, Curtis JP, Fonarow GC, et al. QRS duration, bundle-branch block morphology, and outcomes among older patients with heart failure receiving cardiac resynchronization therapy. JAMA. 2013 Aug 14;310(6):617–26.
Peterson, Pamela N., et al. “QRS duration, bundle-branch block morphology, and outcomes among older patients with heart failure receiving cardiac resynchronization therapy.JAMA, vol. 310, no. 6, Aug. 2013, pp. 617–26. Pubmed, doi:10.1001/jama.2013.8641.
Peterson PN, Greiner MA, Qualls LG, Al-Khatib SM, Curtis JP, Fonarow GC, Hammill SC, Heidenreich PA, Hammill BG, Piccini JP, Hernandez AF, Curtis LH, Masoudi FA. QRS duration, bundle-branch block morphology, and outcomes among older patients with heart failure receiving cardiac resynchronization therapy. JAMA. 2013 Aug 14;310(6):617–626.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

August 14, 2013

Volume

310

Issue

6

Start / End Page

617 / 626

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Risk
  • Retrospective Studies
  • Patient Readmission
  • Medicare
  • Male
  • Humans
  • Heart Failure
  • General & Internal Medicine