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Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: a cohort study. Annals of internal medicine Masoudi, F. A., Mi, X., Curtis, L. H., Peterson, P. N., Curtis, J. P., Fonarow, G. C., Hammill, S. C., Heidenreich, P. A., Al-Khatib, S. M., Piccini, J. P., Qualls, L. G., Hernandez, A. F. 2014; 160 (9): 603-611

Abstract

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.To compare outcomes after CRT-D versus ICD therapy in contemporary practice.Retrospective cohort study using the National Cardiovascular Data Registry's ICD Registry linked with Medicare claims.780 U.S. hospitals implanting both CRT-D and ICD devices.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.Risks for death, readmission, and device-related complications over 3 years.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.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.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.Agency for Healthcare Research and Quality.

View details for DOI 10.7326/M13-1879

View details for PubMedID 24798523