| Autor: |
Shivakumar N; Department of Medicine, Duke University School of Medicine, Durham, NC., Friedman DJ; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC., Fudim M; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC., Abraham WT; Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH., Cleland JGF; National Heart and Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, United Kingdom (J.G.F.C.).; British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (J.G.F.C.)., Curtis AB; Department of Medicine, University at Buffalo, Buffalo, NY., Gold MR; Department of Medicine, Medical University of South Carolina, Charleston, SC., Kutyifa V; Division of Cardiology, Department of Medicine, University of Rochester Medical Center Rochester, NY., Linde C; Karolinska Institutet and Department of Cardiology, Karolinska University, Stockholm, Sweden., Young J; Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, Cleveland, OH., Tang A; Department of Medicine, Western University, Ontario, Canada., Olivas-Martinez A; Department of Biostatistics, University of Washington, Seattle, WA., Inoue LYT; Department of Biostatistics, University of Washington, Seattle, WA., Sanders GD; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.; Duke-Margolis Center for Health Policy, Duke University, Durham, NC.; Evidence Synthesis Group, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC., Al-Khatib SM; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, NC.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC. |
| Abstrakt: |
Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure (HF) symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory NYHA IV vs. III functional class at the time of device implantation. In this meta-analysis, we pooled patient-level data from the MIRACLE, MIRACLE-ICD, and COMPANION trials. Outcomes evaluated were time to the composite endpoint of first HF hospitalization (HFH) or all-cause mortality and time to all-cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian Hierarchical Weibull survival regression model. We assessed if this association differs between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from the RAFT trial. Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to HFH or all-cause mortality (adjusted hazard ratio [aHR] 0.79, 95%CI 0.64 - 0.99, p = 0.044), with a similar association with time to all-cause mortality (aHR 0.78, 95% CI 0.59 - 1.03, p = 0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR 0.72, 95% CI 0.30 - 1.27, p = 0.23 for HFH/mortality; ratio of aHR 0.70, 95% CI 0.35 - 1.34, p = 0.27 for all-cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes. Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV. |
