Adrian F. Hernandez, MD, MHS
What are the benefits of cardiac resynchronization therapy (CRT) in patients with advanced heart failure (HF) and in those with less symptomatic HF?
Included studies compared CRT with inactive, right, or left ventricular pacing alone; implanted cardioverter-defibrillator (ICD) alone; or usual care in > 25 patients with HF and left ventricular ejection fraction (LVEF) ≤ 0.40. Outcomes included all-cause mortality, HF hospitalization, and LVEF.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, 8 other databases, and 8 clinical trial registries were searched to December 2010 for randomized controlled trials (RCTs). References of included studies and reviews, meeting proceedings, and US Food and Drug Administration reports were hand-searched, and primary authors and device manufacturers were contacted. 25 RCTs (n = 9082, mean age range 59 to 73 y, mostly men) met the selection criteria. 6 RCTs were judged to have low risk for bias based on the Cochrane tool. 6 RCTs predominantly included patients with New York Heart Association (NYHA) class I/II symptoms (> 50% but < 100%); 19 RCTs predominantly included patients with NYHA class III/IV symptoms.
Meta-analysis showed that CRT reduced all-cause mortality and HF hospitalization more than control in all patients and in subgroups with predominantly NYHA class I/II symptoms and in those with predominantly class III/IV symptoms. CRT improved LVEF more than control in all patients and those with NYHA class I/II symptoms (4 RCTs, n = 2165, weighted mean difference [WMD] 0.05, 95% CI 0.02 to 0.07) and those with NYHA class III/IV symptoms (7 RCTs, n = 1037, WMD 0.03, CI 0.01 to 0.05).
Cardiac resynchronization therapy reduces mortality and heart failure (HF) hospitalizations more than control in patients with advanced HF and those with less symptomatic HF.
Cardiac resynchronization therapy (CRT) vs control in patients with heart failure (HF)*
*NYAA = New York Heart Association; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from control event rates and relative risks in article using a random-effects model.
Hernandez AF. Review: Cardiac resynchronization reduces mortality and hospitalizations in patients with either more or less symptomatic HF. Ann Intern Med. ;155:JC2–7. doi: 10.7326/0003-4819-155-4-201108160-02007
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Published: Ann Intern Med. 2011;155(4):JC2-7.
Cardiology, Heart Failure, Hospital Medicine.
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