Effects of cardiac resynchronization therapy with or without a defibrillator on survival and hospitalizations in patients with New York Heart Association class IV heart failure

Joann Lindenfeld, Arthur M. Feldman, Leslie Saxon, John Boehmer, Peter Carson, Jalal K. Ghali, Inder Anand, Steve Singh, Jonathan S. Steinberg, Brian Jaski, Teresa DeMarco, David Mann, Patrick Yong, Elizabeth Galle, Fred Ecklund, Michael Bristow

Research output: Contribution to journalArticle

150 Citations (Scopus)

Abstract

BACKGROUND - Cardiac resynchronization therapy (CRT) alone or combined with an implantable defibrillator (CRT-D) has been shown to improve exercise capacity and quality of life and to reduce heart failure (HF) hospitalizations and mortality in patients with New York Heart Association (NYHA) class III and IV HF. There is concern that the device procedure may destabilize these very ill class IV patients. We sought to examine the outcomes of NYHA class IV patients enrolled in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial to assess the potential benefits of CRT and CRT-D. METHODS AND RESULTS - The COMPANION trial randomized 1520 patients with NYHA class III and IV HF to optimal medical therapy, CRT, or CRT-D. In the class IV patients (n=217), the primary end point of time to death or hospitalization for any cause was significantly improved by both CRT (hazard ratio [HR], 0.64; 95% CI, 0.43 to 0.94; P=0.02) and CRT-D (HR, 0.62; 95% CI, 0.42 to 0.90; P=0.01). Time to all-cause death and HF hospitalization was also significantly improved in both CRT (HR, 0.57; 95% CI, 0.37 to 0.87; P=0.01) and CRT-D (HR, 0.49; 95% CI, 0.32 to 0.75; P=0.001) Time to all-cause death trended to an improvement in both CRT (HR, 0.67; 95% CI, 0.41 to 1.10; P=0.11) and CRT-D (HR, 0.63; 95% CI, 0.39 to 1.03; P=0.06). Time to sudden death appeared to be significantly reduced in the CRT-D group (HR, 0.27; 95% CI, 0.08 to 0.90; P=0.03). There was a nonsignificant reduction in time to HF deaths for both CRT (HR, 0.68; 95% CI, 0.34 to 1.37; P=0.28) and CRT-D (HR, 0.79; 95% CI, 0.41 to 1.52; P=0.48). CONCLUSIONS - CRT and CRT-D significantly improve time to all-cause mortality and hospitalizations in NYHA class IV patients, with a trend for improved mortality. These devices should be considered in ambulatory NYHA class IV HF patients similar to those enrolled in COMPANION.

Original languageEnglish (US)
Pages (from-to)204-212
Number of pages9
JournalCirculation
Volume115
Issue number2
DOIs
StatePublished - Jan 1 2007

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Cardiac Resynchronization Therapy
Defibrillators
Hospitalization
Heart Failure
Survival
Mortality
Cause of Death
Equipment and Supplies
Implantable Defibrillators

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Lindenfeld, Joann ; Feldman, Arthur M. ; Saxon, Leslie ; Boehmer, John ; Carson, Peter ; Ghali, Jalal K. ; Anand, Inder ; Singh, Steve ; Steinberg, Jonathan S. ; Jaski, Brian ; DeMarco, Teresa ; Mann, David ; Yong, Patrick ; Galle, Elizabeth ; Ecklund, Fred ; Bristow, Michael. / Effects of cardiac resynchronization therapy with or without a defibrillator on survival and hospitalizations in patients with New York Heart Association class IV heart failure. In: Circulation. 2007 ; Vol. 115, No. 2. pp. 204-212.
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abstract = "BACKGROUND - Cardiac resynchronization therapy (CRT) alone or combined with an implantable defibrillator (CRT-D) has been shown to improve exercise capacity and quality of life and to reduce heart failure (HF) hospitalizations and mortality in patients with New York Heart Association (NYHA) class III and IV HF. There is concern that the device procedure may destabilize these very ill class IV patients. We sought to examine the outcomes of NYHA class IV patients enrolled in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial to assess the potential benefits of CRT and CRT-D. METHODS AND RESULTS - The COMPANION trial randomized 1520 patients with NYHA class III and IV HF to optimal medical therapy, CRT, or CRT-D. In the class IV patients (n=217), the primary end point of time to death or hospitalization for any cause was significantly improved by both CRT (hazard ratio [HR], 0.64; 95{\%} CI, 0.43 to 0.94; P=0.02) and CRT-D (HR, 0.62; 95{\%} CI, 0.42 to 0.90; P=0.01). Time to all-cause death and HF hospitalization was also significantly improved in both CRT (HR, 0.57; 95{\%} CI, 0.37 to 0.87; P=0.01) and CRT-D (HR, 0.49; 95{\%} CI, 0.32 to 0.75; P=0.001) Time to all-cause death trended to an improvement in both CRT (HR, 0.67; 95{\%} CI, 0.41 to 1.10; P=0.11) and CRT-D (HR, 0.63; 95{\%} CI, 0.39 to 1.03; P=0.06). Time to sudden death appeared to be significantly reduced in the CRT-D group (HR, 0.27; 95{\%} CI, 0.08 to 0.90; P=0.03). There was a nonsignificant reduction in time to HF deaths for both CRT (HR, 0.68; 95{\%} CI, 0.34 to 1.37; P=0.28) and CRT-D (HR, 0.79; 95{\%} CI, 0.41 to 1.52; P=0.48). CONCLUSIONS - CRT and CRT-D significantly improve time to all-cause mortality and hospitalizations in NYHA class IV patients, with a trend for improved mortality. These devices should be considered in ambulatory NYHA class IV HF patients similar to those enrolled in COMPANION.",
author = "Joann Lindenfeld and Feldman, {Arthur M.} and Leslie Saxon and John Boehmer and Peter Carson and Ghali, {Jalal K.} and Inder Anand and Steve Singh and Steinberg, {Jonathan S.} and Brian Jaski and Teresa DeMarco and David Mann and Patrick Yong and Elizabeth Galle and Fred Ecklund and Michael Bristow",
year = "2007",
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doi = "10.1161/CIRCULATIONAHA.106.629261",
language = "English (US)",
volume = "115",
pages = "204--212",
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Lindenfeld, J, Feldman, AM, Saxon, L, Boehmer, J, Carson, P, Ghali, JK, Anand, I, Singh, S, Steinberg, JS, Jaski, B, DeMarco, T, Mann, D, Yong, P, Galle, E, Ecklund, F & Bristow, M 2007, 'Effects of cardiac resynchronization therapy with or without a defibrillator on survival and hospitalizations in patients with New York Heart Association class IV heart failure', Circulation, vol. 115, no. 2, pp. 204-212. https://doi.org/10.1161/CIRCULATIONAHA.106.629261

Effects of cardiac resynchronization therapy with or without a defibrillator on survival and hospitalizations in patients with New York Heart Association class IV heart failure. / Lindenfeld, Joann; Feldman, Arthur M.; Saxon, Leslie; Boehmer, John; Carson, Peter; Ghali, Jalal K.; Anand, Inder; Singh, Steve; Steinberg, Jonathan S.; Jaski, Brian; DeMarco, Teresa; Mann, David; Yong, Patrick; Galle, Elizabeth; Ecklund, Fred; Bristow, Michael.

In: Circulation, Vol. 115, No. 2, 01.01.2007, p. 204-212.

Research output: Contribution to journalArticle

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T1 - Effects of cardiac resynchronization therapy with or without a defibrillator on survival and hospitalizations in patients with New York Heart Association class IV heart failure

AU - Lindenfeld, Joann

AU - Feldman, Arthur M.

AU - Saxon, Leslie

AU - Boehmer, John

AU - Carson, Peter

AU - Ghali, Jalal K.

AU - Anand, Inder

AU - Singh, Steve

AU - Steinberg, Jonathan S.

AU - Jaski, Brian

AU - DeMarco, Teresa

AU - Mann, David

AU - Yong, Patrick

AU - Galle, Elizabeth

AU - Ecklund, Fred

AU - Bristow, Michael

PY - 2007/1/1

Y1 - 2007/1/1

N2 - BACKGROUND - Cardiac resynchronization therapy (CRT) alone or combined with an implantable defibrillator (CRT-D) has been shown to improve exercise capacity and quality of life and to reduce heart failure (HF) hospitalizations and mortality in patients with New York Heart Association (NYHA) class III and IV HF. There is concern that the device procedure may destabilize these very ill class IV patients. We sought to examine the outcomes of NYHA class IV patients enrolled in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial to assess the potential benefits of CRT and CRT-D. METHODS AND RESULTS - The COMPANION trial randomized 1520 patients with NYHA class III and IV HF to optimal medical therapy, CRT, or CRT-D. In the class IV patients (n=217), the primary end point of time to death or hospitalization for any cause was significantly improved by both CRT (hazard ratio [HR], 0.64; 95% CI, 0.43 to 0.94; P=0.02) and CRT-D (HR, 0.62; 95% CI, 0.42 to 0.90; P=0.01). Time to all-cause death and HF hospitalization was also significantly improved in both CRT (HR, 0.57; 95% CI, 0.37 to 0.87; P=0.01) and CRT-D (HR, 0.49; 95% CI, 0.32 to 0.75; P=0.001) Time to all-cause death trended to an improvement in both CRT (HR, 0.67; 95% CI, 0.41 to 1.10; P=0.11) and CRT-D (HR, 0.63; 95% CI, 0.39 to 1.03; P=0.06). Time to sudden death appeared to be significantly reduced in the CRT-D group (HR, 0.27; 95% CI, 0.08 to 0.90; P=0.03). There was a nonsignificant reduction in time to HF deaths for both CRT (HR, 0.68; 95% CI, 0.34 to 1.37; P=0.28) and CRT-D (HR, 0.79; 95% CI, 0.41 to 1.52; P=0.48). CONCLUSIONS - CRT and CRT-D significantly improve time to all-cause mortality and hospitalizations in NYHA class IV patients, with a trend for improved mortality. These devices should be considered in ambulatory NYHA class IV HF patients similar to those enrolled in COMPANION.

AB - BACKGROUND - Cardiac resynchronization therapy (CRT) alone or combined with an implantable defibrillator (CRT-D) has been shown to improve exercise capacity and quality of life and to reduce heart failure (HF) hospitalizations and mortality in patients with New York Heart Association (NYHA) class III and IV HF. There is concern that the device procedure may destabilize these very ill class IV patients. We sought to examine the outcomes of NYHA class IV patients enrolled in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial to assess the potential benefits of CRT and CRT-D. METHODS AND RESULTS - The COMPANION trial randomized 1520 patients with NYHA class III and IV HF to optimal medical therapy, CRT, or CRT-D. In the class IV patients (n=217), the primary end point of time to death or hospitalization for any cause was significantly improved by both CRT (hazard ratio [HR], 0.64; 95% CI, 0.43 to 0.94; P=0.02) and CRT-D (HR, 0.62; 95% CI, 0.42 to 0.90; P=0.01). Time to all-cause death and HF hospitalization was also significantly improved in both CRT (HR, 0.57; 95% CI, 0.37 to 0.87; P=0.01) and CRT-D (HR, 0.49; 95% CI, 0.32 to 0.75; P=0.001) Time to all-cause death trended to an improvement in both CRT (HR, 0.67; 95% CI, 0.41 to 1.10; P=0.11) and CRT-D (HR, 0.63; 95% CI, 0.39 to 1.03; P=0.06). Time to sudden death appeared to be significantly reduced in the CRT-D group (HR, 0.27; 95% CI, 0.08 to 0.90; P=0.03). There was a nonsignificant reduction in time to HF deaths for both CRT (HR, 0.68; 95% CI, 0.34 to 1.37; P=0.28) and CRT-D (HR, 0.79; 95% CI, 0.41 to 1.52; P=0.48). CONCLUSIONS - CRT and CRT-D significantly improve time to all-cause mortality and hospitalizations in NYHA class IV patients, with a trend for improved mortality. These devices should be considered in ambulatory NYHA class IV HF patients similar to those enrolled in COMPANION.

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