John L. Sapp, MD
Credit: JACC Journal
A new long-term follow-up study provides insight into the benefits of cardiac resynchronization therapy-defibrillators (CRT-Ds) on survival outcomes in heart failure patients compared to standard implantable cardioverter defibrillators (ICDs). Ta.1
Analysis of the Resynchronized Defibrillation Trial (RAFT) for ambulatory heart failure showed that decreased ejection fraction, widened QRS complexes, and New York Heart Association (NYHA) class II or III heart failure were associated with decreased ejection fraction, widening of the QRS complex, and the incidence of New York Heart Association (NYHA) class II or III heart failure over approximately 14 years of follow-up. It lasted.
“This long-term follow-up study showed a mortality benefit for patients who received CRT-D compared with those who received a standard ICD, and this benefit appeared to persist over time.” RAFT Long wrote. -A period research team led by John L. Sapp, MD, of Dalhousie University’s QEII Health Sciences Center.
CRT has been shown to reduce both mortality and heart failure outcomes in patients with symptomatic heart failure, reduced ejection fraction, and wide QRS complexes despite optimal drug therapy, and in appropriate patients. It has been established as standard treatment.2 Implantation of a CRT device is a lifelong intervention, suggesting that clinical decision-making is dependent on the results of long-term outcome studies of CRT.
Across the double-blind, randomized, controlled RAFT trial, which followed approximately 1,800 patients for an average of 40 months, CRT significantly reduced the risk of death or hospitalization for heart failure than implantable cardioverter defibrillators (ICDs). indicated (hazard ratio [HR]0.75; 95% CI, 0.64 to 0.87. P <.001).3 Secondary outcome events, including death from any cause, death from any cardiovascular disease, and hospitalization for heart failure, were significantly lower with CRT.
To gather evidence about the long-term effects of CRT on mortality, Sapp et al. evaluated survival outcomes for patients enrolled at the eight centers with the highest number of participants.1 Eligible participants with NYHA Class II or III heart failure, left ventricular ejection fraction ≤30%, and intrinsic QRS duration ≥120 ms to receive either an ICD alone or a CRT-defibrillator (CRT-D). randomly assigned.
These patients were observed at a follow-up visit 1 month after device implantation and every 6 months until all patients had at least 18 months of follow-up. Each follow-up visit consisted of a clinical evaluation and device inspection. The primary outcome of the study was death from any cause, and important secondary outcomes included the composite of death from any cause, heart transplantation, or ventricular assist device implantation.
The RAFT study enrolled 1,798 patients at 34 sites. In the long-term survival trial, 1,050 patients from eight centers were included in the analysis. The first patient was enrolled in January 2003 and was followed until death or December 31, 2021. Median follow-up for the entire study population was 7.8 years, and median follow-up for survivors was 13.9 years. Year.
In their analysis, researchers found that death occurred in 405 of 530 patients (76.4%) assigned to the ICD group and in 370 of 520 patients (71.2%) assigned to the CRT-D group. I discovered that. Based on these data, the research team showed that the time to death was longer in the CRT-D group than in the ICD group (acceleration factor, 0.80; 95% CI, 0.69 to 0.92; P = .002).
Meanwhile, secondary outcome events occurred in 392 patients (75.4%) in the CRT-D group and 412 patients (77.7%) in the ICD group. Again, the time to reach the composite endpoint was shown to be longer in his CRT-D group than in the ICD group (acceleration factor, 0.85; 95% CI, 0.74–0.98).
Sapp et al. noted that the RAFT results complement observations from other randomized controlled trials, such as the MADIT-CRT and CARE-HF trials. Each trial reported reduced mortality and long-term persistence of the original benefits of CRT implantation.
“The current study extends these observations over a longer follow-up period and shows that survival improvements persist in patients with heart failure, reduced left ventricular ejection fraction, and prolonged QRS duration who received CRT-D devices. ”, the researchers wrote. .
References
- NEJM
- Tang ASL, Wells GA, Talajic M, et al. Cardiac resynchronization therapy for mild to moderate heart failure. N Engl J Med 2010;363:2385-95
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guidelines for Heart Failure Management: Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. circulation 2022;145(18):e895-e1032