Comparison of left ventricular lead upgrade vs continued medical care among patients eligible for cardiac resynchronization therapy at the time of defibrillator generator replacement: Predictors of left ventricular lead upgrade and associations with long-term outcomes
Randomized trials evaluating cardiac resynchronization therapy (CRT) have excluded patients with a pre-existing implantable cardioverter–defibrillator (ICD). The association of CRT upgrade with clinical outcomes in patients with a pre-existing ICD is unclear. The purpose of this study was to examine...
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| Veröffentlicht in: | Heart rhythm 2020-11, Vol.17 (11), p.1878-1886 |
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| container_title | Heart rhythm |
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| creator | Hyman, Matthew C. Bao, Haikun Curtis, Jeptha P. Minges, Karl Schaller, Robert D. Birgersdotter-Green, Ulrika Marchlinski, Francis E. Hsu, Jonathan C. |
| description | Randomized trials evaluating cardiac resynchronization therapy (CRT) have excluded patients with a pre-existing implantable cardioverter–defibrillator (ICD). The association of CRT upgrade with clinical outcomes in patients with a pre-existing ICD is unclear.
The purpose of this study was to examine a CRT-eligible population to evaluate clinical outcomes associated with CRT upgrade compared to patients who did not undergo CRT.
Using the National Cardiovascular Data Registry (NCDR) ICD Registry between April 2010 and December 2014, we created a hierarchical logistic regression model to identify predictors of CRT upgrade in a CRT-eligible ICD population. In the subpopulation of patients with Medicare-linked claims data, differential outcomes were determined with censoring at 3 years. The primary endpoint of this study was all-cause mortality, with secondary endpoints of rates of hospitalization and procedural complications.
CRT upgrade was performed in 75.5% of CRT-eligible patients with pre-existing ICD (n = 15,803). Presence of left bundle branch block conduction was the strongest predictor of CRT upgrade (odds ratio [OR] 4.56; 95% confidence interval [CI] 4.08–5.11; P |
| doi_str_mv | 10.1016/j.hrthm.2020.05.032 |
| format | Article |
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The purpose of this study was to examine a CRT-eligible population to evaluate clinical outcomes associated with CRT upgrade compared to patients who did not undergo CRT.
Using the National Cardiovascular Data Registry (NCDR) ICD Registry between April 2010 and December 2014, we created a hierarchical logistic regression model to identify predictors of CRT upgrade in a CRT-eligible ICD population. In the subpopulation of patients with Medicare-linked claims data, differential outcomes were determined with censoring at 3 years. The primary endpoint of this study was all-cause mortality, with secondary endpoints of rates of hospitalization and procedural complications.
CRT upgrade was performed in 75.5% of CRT-eligible patients with pre-existing ICD (n = 15,803). Presence of left bundle branch block conduction was the strongest predictor of CRT upgrade (odds ratio [OR] 4.56; 95% confidence interval [CI] 4.08–5.11; P <.0001). In both unadjusted and adjusted analyses, CRT upgrade was associated with a reduction in mortality at 3 years (unadjusted hazard ratio [HR] 0.80; 95% CI 0.70–0.92; P = .001; adjusted HR 0.84; 95% CI 0.72–0.98; P = .02, respectively). Compared to patients with ICD generator replacement only, patients who underwent CRT upgrade experienced no different 3-year rates of hospitalization (adjusted HR 1.01; 95% CI 0.91–1.12; P = .81) or 1-year periprocedural complication rates (adjusted HR 1.07; 95% CI 0.79–1.45; P = .66).
In a national registry of CRT-eligible patients with pre-existing ICD, upgrade to CRT was associated with lower rates of mortality than continued medical management.</description><identifier>ISSN: 1547-5271</identifier><identifier>EISSN: 1556-3871</identifier><identifier>DOI: 10.1016/j.hrthm.2020.05.032</identifier><identifier>PMID: 32497762</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adverse events ; Cardiac resynchronization therapy ; Generator replacement ; Implantable-cardioverter defibrillator ; Mortality</subject><ispartof>Heart rhythm, 2020-11, Vol.17 (11), p.1878-1886</ispartof><rights>2020 Heart Rhythm Society</rights><rights>Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-173e0cf1baea6e9f29e529a094098b8233c359ff8e1c9f6a17b5c8b27848d2a23</citedby><cites>FETCH-LOGICAL-c359t-173e0cf1baea6e9f29e529a094098b8233c359ff8e1c9f6a17b5c8b27848d2a23</cites><orcidid>0000-0002-4050-6925</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1547527120305300$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32497762$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hyman, Matthew C.</creatorcontrib><creatorcontrib>Bao, Haikun</creatorcontrib><creatorcontrib>Curtis, Jeptha P.</creatorcontrib><creatorcontrib>Minges, Karl</creatorcontrib><creatorcontrib>Schaller, Robert D.</creatorcontrib><creatorcontrib>Birgersdotter-Green, Ulrika</creatorcontrib><creatorcontrib>Marchlinski, Francis E.</creatorcontrib><creatorcontrib>Hsu, Jonathan C.</creatorcontrib><title>Comparison of left ventricular lead upgrade vs continued medical care among patients eligible for cardiac resynchronization therapy at the time of defibrillator generator replacement: Predictors of left ventricular lead upgrade and associations with long-term outcomes</title><title>Heart rhythm</title><addtitle>Heart Rhythm</addtitle><description>Randomized trials evaluating cardiac resynchronization therapy (CRT) have excluded patients with a pre-existing implantable cardioverter–defibrillator (ICD). The association of CRT upgrade with clinical outcomes in patients with a pre-existing ICD is unclear.
The purpose of this study was to examine a CRT-eligible population to evaluate clinical outcomes associated with CRT upgrade compared to patients who did not undergo CRT.
Using the National Cardiovascular Data Registry (NCDR) ICD Registry between April 2010 and December 2014, we created a hierarchical logistic regression model to identify predictors of CRT upgrade in a CRT-eligible ICD population. In the subpopulation of patients with Medicare-linked claims data, differential outcomes were determined with censoring at 3 years. The primary endpoint of this study was all-cause mortality, with secondary endpoints of rates of hospitalization and procedural complications.
CRT upgrade was performed in 75.5% of CRT-eligible patients with pre-existing ICD (n = 15,803). Presence of left bundle branch block conduction was the strongest predictor of CRT upgrade (odds ratio [OR] 4.56; 95% confidence interval [CI] 4.08–5.11; P <.0001). In both unadjusted and adjusted analyses, CRT upgrade was associated with a reduction in mortality at 3 years (unadjusted hazard ratio [HR] 0.80; 95% CI 0.70–0.92; P = .001; adjusted HR 0.84; 95% CI 0.72–0.98; P = .02, respectively). Compared to patients with ICD generator replacement only, patients who underwent CRT upgrade experienced no different 3-year rates of hospitalization (adjusted HR 1.01; 95% CI 0.91–1.12; P = .81) or 1-year periprocedural complication rates (adjusted HR 1.07; 95% CI 0.79–1.45; P = .66).
In a national registry of CRT-eligible patients with pre-existing ICD, upgrade to CRT was associated with lower rates of mortality than continued medical management.</description><subject>Adverse events</subject><subject>Cardiac resynchronization therapy</subject><subject>Generator replacement</subject><subject>Implantable-cardioverter defibrillator</subject><subject>Mortality</subject><issn>1547-5271</issn><issn>1556-3871</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNqFkk1v1DAQhgMC0dLyC5CQj1yy-COfSByqFS1IleAAZ2vijHe9SuIwdhYtvx6nWzjCySPref3OeN4sey34RnBRvTts9hT340ZyyTe83HAln2aXoiyrXDW1eLbWRZ2XshYX2csQDpzLtuLqRXahZNHWdSUvn1xv_TgDueAn5i0b0EZ2xCmSM8sAlC6gZ8u8I-iRHQMzfopuWrBnI_bOwMAMEDIY_bRjM0SXtIHh4HauG5BZTyvQOzCMMJwmsyc_uV8JTIZxjwTziUFcSxbdiGsTPVrXkRsGiEm-wylRa0U4D2BwTBbv2Vda_dN1-H_fMPUMQvDGPfgG9tPFPRtSy3lEGplfovEjhuvsuYUh4KvH8yr7fvvx2_ZTfv_l7vP25j43qmxjLmqF3FjRAUKFrZUtlrIF3ha8bbpGKrVy1jYoTGsrEHVXmqaTdVM0vQSprrK353dn8j8WDFGPLhhMA0_ol6BlIbgqpeR1QtUZNeRDILR6JjcCnbTgeo2BPuiHGOg1BpqXOsUgqd48Gixd2tNfzZ-9J-DDGcA05tEh6WDS6kz6U0ITde_dPw1-A_tDzXM</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Hyman, Matthew C.</creator><creator>Bao, Haikun</creator><creator>Curtis, Jeptha P.</creator><creator>Minges, Karl</creator><creator>Schaller, Robert D.</creator><creator>Birgersdotter-Green, Ulrika</creator><creator>Marchlinski, Francis E.</creator><creator>Hsu, Jonathan C.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4050-6925</orcidid></search><sort><creationdate>202011</creationdate><title>Comparison of left ventricular lead upgrade vs continued medical care among patients eligible for cardiac resynchronization therapy at the time of defibrillator generator replacement: Predictors of left ventricular lead upgrade and associations with long-term outcomes</title><author>Hyman, Matthew C. ; Bao, Haikun ; Curtis, Jeptha P. ; Minges, Karl ; Schaller, Robert D. ; Birgersdotter-Green, Ulrika ; Marchlinski, Francis E. ; Hsu, Jonathan C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-173e0cf1baea6e9f29e529a094098b8233c359ff8e1c9f6a17b5c8b27848d2a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adverse events</topic><topic>Cardiac resynchronization therapy</topic><topic>Generator replacement</topic><topic>Implantable-cardioverter defibrillator</topic><topic>Mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hyman, Matthew C.</creatorcontrib><creatorcontrib>Bao, Haikun</creatorcontrib><creatorcontrib>Curtis, Jeptha P.</creatorcontrib><creatorcontrib>Minges, Karl</creatorcontrib><creatorcontrib>Schaller, Robert D.</creatorcontrib><creatorcontrib>Birgersdotter-Green, Ulrika</creatorcontrib><creatorcontrib>Marchlinski, Francis E.</creatorcontrib><creatorcontrib>Hsu, Jonathan C.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Heart rhythm</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hyman, Matthew C.</au><au>Bao, Haikun</au><au>Curtis, Jeptha P.</au><au>Minges, Karl</au><au>Schaller, Robert D.</au><au>Birgersdotter-Green, Ulrika</au><au>Marchlinski, Francis E.</au><au>Hsu, Jonathan C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of left ventricular lead upgrade vs continued medical care among patients eligible for cardiac resynchronization therapy at the time of defibrillator generator replacement: Predictors of left ventricular lead upgrade and associations with long-term outcomes</atitle><jtitle>Heart rhythm</jtitle><addtitle>Heart Rhythm</addtitle><date>2020-11</date><risdate>2020</risdate><volume>17</volume><issue>11</issue><spage>1878</spage><epage>1886</epage><pages>1878-1886</pages><issn>1547-5271</issn><eissn>1556-3871</eissn><abstract>Randomized trials evaluating cardiac resynchronization therapy (CRT) have excluded patients with a pre-existing implantable cardioverter–defibrillator (ICD). The association of CRT upgrade with clinical outcomes in patients with a pre-existing ICD is unclear.
The purpose of this study was to examine a CRT-eligible population to evaluate clinical outcomes associated with CRT upgrade compared to patients who did not undergo CRT.
Using the National Cardiovascular Data Registry (NCDR) ICD Registry between April 2010 and December 2014, we created a hierarchical logistic regression model to identify predictors of CRT upgrade in a CRT-eligible ICD population. In the subpopulation of patients with Medicare-linked claims data, differential outcomes were determined with censoring at 3 years. The primary endpoint of this study was all-cause mortality, with secondary endpoints of rates of hospitalization and procedural complications.
CRT upgrade was performed in 75.5% of CRT-eligible patients with pre-existing ICD (n = 15,803). Presence of left bundle branch block conduction was the strongest predictor of CRT upgrade (odds ratio [OR] 4.56; 95% confidence interval [CI] 4.08–5.11; P <.0001). In both unadjusted and adjusted analyses, CRT upgrade was associated with a reduction in mortality at 3 years (unadjusted hazard ratio [HR] 0.80; 95% CI 0.70–0.92; P = .001; adjusted HR 0.84; 95% CI 0.72–0.98; P = .02, respectively). Compared to patients with ICD generator replacement only, patients who underwent CRT upgrade experienced no different 3-year rates of hospitalization (adjusted HR 1.01; 95% CI 0.91–1.12; P = .81) or 1-year periprocedural complication rates (adjusted HR 1.07; 95% CI 0.79–1.45; P = .66).
In a national registry of CRT-eligible patients with pre-existing ICD, upgrade to CRT was associated with lower rates of mortality than continued medical management.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32497762</pmid><doi>10.1016/j.hrthm.2020.05.032</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-4050-6925</orcidid></addata></record> |
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| language | eng |
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| source | Elsevier ScienceDirect Journals Complete |
| subjects | Adverse events Cardiac resynchronization therapy Generator replacement Implantable-cardioverter defibrillator Mortality |
| title | Comparison of left ventricular lead upgrade vs continued medical care among patients eligible for cardiac resynchronization therapy at the time of defibrillator generator replacement: Predictors of left ventricular lead upgrade and associations with long-term outcomes |
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