Frederick A. Masoudi, MD, MSPH; Xiaojuan Mi, PhD; Lesley H. Curtis, PhD; Pamela N. Peterson, MD, MSPH; Jeptha P. Curtis, MD; Gregg C. Fonarow, MD; Stephen C. Hammill, MD; Paul A. Heidenreich, MD; Sana M. Al-Khatib, MD, MHS; Jonathan P. Piccini, MD, MHS; Laura G. Qualls, MS; Adrian F. Hernandez, MD, MHS
Disclaimer: The authors of this article are responsible for its content. Statements in this article should not be construed as endorsement by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, or National Cardiovascular Data Registry or its associated professional societies identified at www.ncdr.com.
Acknowledgment: The authors thank Damon M. Seils, MA, from Duke University, who provided editorial assistance and prepared the manuscript.
Financial Support: By contract HHSA29020050032I (Duke University Developing Evidence to Inform Decisions about Effectiveness Center) from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services, as part of the Developing Evidence to Inform Decisions about Effectiveness program, and the American College of Cardiology Foundation's National Cardiovascular Data Registry. The ICD Registry is an initiative of the American College of Cardiology Foundation and the Heart Rhythm Society. Dr. Peterson is supported by grant K08HS019814 from the Agency for Healthcare Research and Quality.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1879.
Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Curtis (e-mail, firstname.lastname@example.org). Data set: Available at www.ncdr.com/research.
Requests for Single Reprints: Frederick A. Masoudi, MD, MSPH, Division of Cardiology, University of Colorado Anschutz Medical Campus, Box B132, Room 522, 12401 East 17th Avenue, Aurora, CO 80045; e-mail, email@example.com.
Current Author Addresses: Dr. Masoudi: Division of Cardiology, Anschutz Medical Campus, Box B132, Room 522, 12401 East 17th Avenue, Aurora, CO 80045.
Drs. Mi, Curtis, Al-Khatib, Piccini, Qualls, and Hernandez: Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715.
Dr. Peterson: Division of Cardiology, Denver Health Medical Center, Box 0960, 777 Bannock Street, Denver, CO 80204.
Dr. Curtis: Yale School of Medicine, PO Box 208056, 333 Cedar Street, New Haven, CT 06520-8056.
Dr. Fonarow: Ahmanson–University of California, Los Angeles, Cardiomyopathy Center, 200 UCLA Medical Plaza, Suite 224, Los Angeles, CA 90095.
Dr. Hammill: Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Dr. Heidenreich: Veterans Affairs Palo Alto Medical Center, 111C Cardiology, 3801 Miranda Avenue, Palo Alto, CA 94304.
Author Contributions: Conception and design: F.A. Masoudi, L.H. Curtis, G.C. Fonarow, S.M. Al-Khatib, L.G. Qualls, A.F. Hernandez.
Analysis and interpretation of the data: F.A. Masoudi, X. Mi, L.H. Curtis, J.P. Curtis, G.C. Fonarow, P.A. Heidenreich, S.M. Al-Khatib, J.P. Piccini, A.F. Hernandez.
Drafting of the article: F.A. Masoudi, X. Mi.
Critical revision of the article for important intellectual content: F.A. Masoudi, L.H. Curtis, P.N. Peterson, J.P. Curtis, G.C. Fonarow, S.C. Hammill, P.A. Heidenreich, S.M. Al-Khatib, J.P. Piccini, L.G. Qualls, A.F. Hernandez.
Final approval of the article: F.A. Masoudi, L.H. Curtis, P.N. Peterson, J.P. Curtis, G.C. Fonarow, S.C. Hammill, P.A. Heidenreich, S.M. Al-Khatib, J.P. Piccini, A.F. Hernandez.
Provision of study materials or patients: G.C. Fonarow.
Obtaining of funding: L.H. Curtis, A.F. Hernandez.
Administrative, technical, or logistic support: L.H. Curtis, S.C. Hammill, L.G. Qualls, A.F. Hernandez.
Collection and assembly of data: F.A. Masoudi, G.C. Fonarow, S.C. Hammill
Masoudi FA, Mi X, Curtis LH, Peterson PN, Curtis JP, Fonarow GC, et al. Comparative Effectiveness of Cardiac Resynchronization Therapy With an Implantable Cardioverter-Defibrillator Versus Defibrillator Therapy Alone: A Cohort Study. Ann Intern Med. 2014;160:603-611. doi: 10.7326/M13-1879
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Published: Ann Intern Med. 2014;160(9):603-611.
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.
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