1. Clinical Characteristics and Outcomes of Older Cardiac Resynchronization Therapy Recipients Using a Pacemaker versus a Defibrillator.
- Author
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MUNIR, MUHAMMAD BILAL, ALTHOUSE, ANDREW D., RIJAL, SHASANK, SHAH, MAULIN BHARAT, ABU DAYA, HUSSEIN, ADELSTEIN, EVAN, and SABA, SAMIR
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HEART failure treatment , *CARDIAC pacemakers , *CARDIAC pacing , *CHI-squared test , *COMPARATIVE studies , *CONFIDENCE intervals , *ECHOCARDIOGRAPHY , *ELECTROCARDIOGRAPHY , *FISHER exact test , *IMPLANTABLE cardioverter-defibrillators , *LONGITUDINAL method , *MULTIVARIATE analysis , *PROBABILITY theory , *MATHEMATICAL variables , *COMORBIDITY , *TREATMENT effectiveness , *PROPORTIONAL hazards models , *RETROSPECTIVE studies , *DATA analysis software , *DESCRIPTIVE statistics , *KAPLAN-Meier estimator , *MANN Whitney U Test , *VENTRICULAR ejection fraction - Abstract
CRT-P versus CRT-D Outcomes Background Cardiac resynchronization therapy (CRT) is commonly used to manage heart failure, yet published guidelines do not distinguish between recommendations for pacemakers (CRT-P) and defibrillators (CRT-D) despite significant differences in size, longevity, and cost between these devices. The purpose of this study is to compare the clinical characteristics and outcomes between elderly recipients of CRT-P and CRT-D. Methods and Results Data from 512 patients (405 CRT-D, 107 CRT-P) aged ≥75 years with LV ejection fraction ≤35% and QRS duration >120 milliseconds were retrospectively analyzed for baseline characteristics and followed to the primary outcome of all-cause mortality. Cox proportional hazards models were used to adjust for possible confounders. Results were further validated through propensity matching cohorts. Compared to CRT-D recipients, CRT-P patients were older (83 years vs. 81 years, P < 0.001) and had more comorbid conditions (Charlson index = 5 [3-6] vs. 4 [3-5], P = 0.007). During 40.8 months of follow-up, there were 280 deaths. Compared to CRT-D patients, CRT-P recipients had higher unadjusted mortality (HR 1.54, 95% CI 1.15-2.08, P = 0.004). However, this difference lost significance after adjusting for baseline differences between the groups (HR 1.18, 95% CI 0.78-1.77, P = 0.435). Conclusion Higher all-cause mortality in older CRT-P versus CRT-D patients is largely explained by baseline clinical and demographic differences between the two groups, which are likely the drivers of device selection in real-world clinical practice, where the published guidelines remain ambiguous. There is a need for randomized studies to determine optimal CRT device selection. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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