The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF

Aims Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically,...

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Published in:European journal of heart failure 2022-06, Vol.24 (6), p.1080-1090
Main Authors: Cleland, John G.F., Bristow, Michael R., Freemantle, Nicholas, Olshansky, Brian, Gras, Daniel, Saxon, Leslie, Tavazzi, Luigi, Boehmer, John, Ghio, Stefano, Feldman, Arthur M., Daubert, Jean‐Claude, Mets, David
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists
Aged
Body surface area
Cardiac resynchronization therapy
Cardiac Resynchronization Therapy - methods
Defibrillators
Defibrillators, Implantable
Female
Heart failure
Heart Failure - epidemiology
Heart Failure - therapy
Humans
Individual patient data meta‐analysis
Male
Morbidity
Mortality
Sex
Stroke Volume
Treatment Outcome
Ventricular Function, Left
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Summary:Aims Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically, of CRT pacemakers (CRT‐P) on all‐cause mortality or the composite of hospitalization for heart failure or all‐cause mortality. Methods and results We conducted an individual patient data meta‐analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization‐Heart Failure (CARE‐HF) trials. Only patients assigned to CRT‐P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. Median age was 67 (59–73) years, most patients were men (70%), 68% had a QRS duration of 150–199 ms and 80% had left bundle branch block. Patients assigned to CRT‐P had lower rates for all‐cause mortality (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.56–0.81; p 
ISSN:1388-9842
1879-0844
1879-0844
DOI:10.1002/ejhf.2524