Survival of patients undergoing cardiac resynchronization therapy with or without defibrillator: the RESET-CRT project
Key result
CRT-P is associated with similar survival compared to CRT-D.
- HR 0.99
- 95% CI 0.81-1.20
- n=3,569
Why the study?
Does CRT-P provide similar survival compared to CRT-D in patients undergoing de novo CRT implantation without secondary prevention indications?
Population
3,569 patients undergoing de novo cardiac resynchronization therapy implantation from 2014 to 2019 without…
Comparison
Cardiac resynchronization therapy with pacemaker vs Cardiac resynchronization therapy with…
Design
Cohort
Follow-up
median 2.35 years
Authors
Discussion
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Implication
Supports CRT-P consideration to avoid defibrillator risks in selected patients; leaves open randomized confirmation of equivalence.
Key Points
- To compare survival rates between patients receiving cardiac resynchronization therapy with defibrillator (CRT-D) versus pacemaker (CRT-P).
- Analyzed health claims data from 2014 to 2019 for patients undergoing de novo CRT implantation.
- Utilized age-adjusted Cox proportional hazards regression and entropy balancing techniques to control for baseline imbalances.
- Sample included 847 CRT-P and 2722 CRT-D patients with median follow-up of 2.35 years.
- Initial unadjusted analysis showed higher death rate in CRT-D patients (HR: 1.63, 95% CI: 1.38-1.92).
- After age adjustment, HR was 1.13 (95% CI: 0.95-1.35); after entropy balancing, HR was 0.99 (95% CI: 0.81-1.20).
- No observed survival differences among different age groups, indicating robustness of results.
Study Design
Type
Cohort (n=3,569)
Multicenter
Yes
Structured PICO
Does CRT-P provide similar survival compared to CRT-D in patients undergoing de novo CRT implantation without secondary prevention indications?
P
Population
3,569 heart failure patients undergoing de novo CRT implantation without indication for secondary prevention of sudden cardiac death, followed for a median of 2.35 years.
E
Exposure
Cardiac resynchronization therapy with pacemaker (CRT-P)
C
Comparator
Cardiac resynchronization therapy with defibrillator (CRT-D)
O
Outcome
All-cause death at median 2.35 years follow-uphard clinical
Main Result
Hazard Ratio: 0.99 (95% CI 0.81–1.2)
In patients receiving de novo CRT without secondary prevention indications, CRT-P offers similar survival to CRT-D after adjusting for age and baseline imbalances.
Cite This Study
Hadwiger et al. (2022) conducted a cohort in Heart failure (n=3,569). Cardiac resynchronization therapy with pacemaker (CRT-P) vs. Cardiac resynchronization therapy with defibrillator (CRT-D) was evaluated on All-cause death (HR 0.99, 95% CI 0.81-1.20). Cardiac resynchronization therapy with pacemaker (CRT-P) was not associated with inferior survival compared to CRT with defibrillator (CRT-D) (HR 0.99; 95% CI 0.81-1.20).