The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF
Aims Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically,...
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| Veröffentlicht in: | European journal of heart failure 2022-06, Vol.24 (6), p.1080-1090 |
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| creator | Cleland, John G.F. Bristow, Michael R. Freemantle, Nicholas Olshansky, Brian Gras, Daniel Saxon, Leslie Tavazzi, Luigi Boehmer, John Ghio, Stefano Feldman, Arthur M. Daubert, Jean‐Claude Mets, David |
| description | Aims
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically, of CRT pacemakers (CRT‐P) on all‐cause mortality or the composite of hospitalization for heart failure or all‐cause mortality.
Methods and results
We conducted an individual patient data meta‐analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization‐Heart Failure (CARE‐HF) trials. Only patients assigned to CRT‐P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. Median age was 67 (59–73) years, most patients were men (70%), 68% had a QRS duration of 150–199 ms and 80% had left bundle branch block. Patients assigned to CRT‐P had lower rates for all‐cause mortality (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.56–0.81; p |
| doi_str_mv | 10.1002/ejhf.2524 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2658233359</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2658233359</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3604-b2e08f5ec3ecb38e8c41cd4a6c818e34090dd2e5e53d0a35e9d6c0df1642f3393</originalsourceid><addsrcrecordid>eNp1kc1O3DAURi3Uqvy0C16g8rIsAo7tBKe70WimQ0WZqqLryLGvNUZJPLUdUFj1EXgFXo0nqcNQdqx8P92jY9kfQsc5Oc0JoWdwszGntKB8Dx3k4rzKiOD8XZqZEFklON1HhyHcEJKfJ_wD2mcFrwhj1QF6vN4ABmNARewMVtJrKxX2EMZebbzr7b2M1vX4zsaNGyKWWIOxjbdtK6PzOK065xurbRyx7PWUomxT-poitr22t1YPssXbJII-Yi2jxB1E-fT3QfayHYMN093z9Y-fs6uL9dWzZj77tUjAavkRvTeyDfDp5TxCv5eL6_kqu1x_u5jPLjPFSsKzhgIRpgDFQDVMgFA8V5rLUolcAOOkIlpTKKBgmkhWQKVLRbTJS05N-gp2hL7svFvv_gwQYt3ZoCA9swc3hJqWhaCMsWJCT3ao8i4ED6beettJP9Y5qadG6qmRemoksZ9ftEPTgX4l_1eQgLMdcGdbGN821Yvvq-Wz8h8muZnn</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2658233359</pqid></control><display><type>article</type><title>The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Cleland, John G.F. ; Bristow, Michael R. ; Freemantle, Nicholas ; Olshansky, Brian ; Gras, Daniel ; Saxon, Leslie ; Tavazzi, Luigi ; Boehmer, John ; Ghio, Stefano ; Feldman, Arthur M. ; Daubert, Jean‐Claude ; Mets, David</creator><creatorcontrib>Cleland, John G.F. ; Bristow, Michael R. ; Freemantle, Nicholas ; Olshansky, Brian ; Gras, Daniel ; Saxon, Leslie ; Tavazzi, Luigi ; Boehmer, John ; Ghio, Stefano ; Feldman, Arthur M. ; Daubert, Jean‐Claude ; Mets, David</creatorcontrib><description>Aims
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically, of CRT pacemakers (CRT‐P) on all‐cause mortality or the composite of hospitalization for heart failure or all‐cause mortality.
Methods and results
We conducted an individual patient data meta‐analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization‐Heart Failure (CARE‐HF) trials. Only patients assigned to CRT‐P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. Median age was 67 (59–73) years, most patients were men (70%), 68% had a QRS duration of 150–199 ms and 80% had left bundle branch block. Patients assigned to CRT‐P had lower rates for all‐cause mortality (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.56–0.81; p < 0.0001) and the composite outcome (HR 0.67, 95% CI 0.58–0.78; p < 0.0001). No pre‐specified characteristic, including sex, aetiology of ventricular dysfunction, QRS duration (within the studied range) or morphology or PR interval significantly influenced the effect of CRT‐P on all‐cause mortality or the composite outcome. However, CRT‐P had a greater effect on the composite outcome for patients with lower body surface area and those prescribed beta‐blockers.
Conclusions
Cardiac resynchronization therapy‐pacemaker reduces morbidity and mortality in appropriately selected patients with heart failure. Benefits may be greater in smaller patients and in those receiving beta‐blockers. Neither QRS duration nor morphology independently predicted the benefit of CRT‐P.
Clinical Trial Registration: COMPANION, NCT00180258; CARE‐HF, NCT00170300.
Potential substrates for and mechanisms of action for cardiac resynchronization therapy pacemakers (CRT‐P). Kaplan–Meier estimates for all‐cause mortality (hazard ratio 0.68, 95% confidence interval [CI] 0.56–0.81; p < 0.0001) and time to composite of first hospitalization for heart failure or all‐cause mortality (hazard ratio 0.67, 95% CI 0.58–0.78; p < 0.0001). No heterogeneity was identified in the effect of CRT‐P on mortality amongst trial participants. CRT‐P had greater effects on the composite outcome (hospitalization for heart failure or all‐cause mortality) for those taking beta‐blockers and patients of smaller stature. Although women are, on average, smaller than men, no interaction between CRT‐P and sex was observed. Similar trends were observed when only men were included in the analysis. These analyses suggest that stature rather than sex is associated with the effect of CRT‐P on outcome. LBBB, left bundle branch block.</description><identifier>ISSN: 1388-9842</identifier><identifier>ISSN: 1879-0844</identifier><identifier>EISSN: 1879-0844</identifier><identifier>DOI: 10.1002/ejhf.2524</identifier><identifier>PMID: 35490339</identifier><language>eng</language><publisher>Oxford, UK: John Wiley & Sons, Ltd</publisher><subject>Adrenergic beta-Antagonists ; Aged ; Body surface area ; Cardiac resynchronization therapy ; Cardiac Resynchronization Therapy - methods ; Defibrillators ; Defibrillators, Implantable ; Female ; Heart failure ; Heart Failure - epidemiology ; Heart Failure - therapy ; Humans ; Individual patient data meta‐analysis ; Male ; Morbidity ; Mortality ; Sex ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left</subject><ispartof>European journal of heart failure, 2022-06, Vol.24 (6), p.1080-1090</ispartof><rights>2022 The Authors. published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.</rights><rights>2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3604-b2e08f5ec3ecb38e8c41cd4a6c818e34090dd2e5e53d0a35e9d6c0df1642f3393</citedby><cites>FETCH-LOGICAL-c3604-b2e08f5ec3ecb38e8c41cd4a6c818e34090dd2e5e53d0a35e9d6c0df1642f3393</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fejhf.2524$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fejhf.2524$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35490339$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cleland, John G.F.</creatorcontrib><creatorcontrib>Bristow, Michael R.</creatorcontrib><creatorcontrib>Freemantle, Nicholas</creatorcontrib><creatorcontrib>Olshansky, Brian</creatorcontrib><creatorcontrib>Gras, Daniel</creatorcontrib><creatorcontrib>Saxon, Leslie</creatorcontrib><creatorcontrib>Tavazzi, Luigi</creatorcontrib><creatorcontrib>Boehmer, John</creatorcontrib><creatorcontrib>Ghio, Stefano</creatorcontrib><creatorcontrib>Feldman, Arthur M.</creatorcontrib><creatorcontrib>Daubert, Jean‐Claude</creatorcontrib><creatorcontrib>Mets, David</creatorcontrib><title>The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF</title><title>European journal of heart failure</title><addtitle>Eur J Heart Fail</addtitle><description>Aims
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically, of CRT pacemakers (CRT‐P) on all‐cause mortality or the composite of hospitalization for heart failure or all‐cause mortality.
Methods and results
We conducted an individual patient data meta‐analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization‐Heart Failure (CARE‐HF) trials. Only patients assigned to CRT‐P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. Median age was 67 (59–73) years, most patients were men (70%), 68% had a QRS duration of 150–199 ms and 80% had left bundle branch block. Patients assigned to CRT‐P had lower rates for all‐cause mortality (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.56–0.81; p < 0.0001) and the composite outcome (HR 0.67, 95% CI 0.58–0.78; p < 0.0001). No pre‐specified characteristic, including sex, aetiology of ventricular dysfunction, QRS duration (within the studied range) or morphology or PR interval significantly influenced the effect of CRT‐P on all‐cause mortality or the composite outcome. However, CRT‐P had a greater effect on the composite outcome for patients with lower body surface area and those prescribed beta‐blockers.
Conclusions
Cardiac resynchronization therapy‐pacemaker reduces morbidity and mortality in appropriately selected patients with heart failure. Benefits may be greater in smaller patients and in those receiving beta‐blockers. Neither QRS duration nor morphology independently predicted the benefit of CRT‐P.
Clinical Trial Registration: COMPANION, NCT00180258; CARE‐HF, NCT00170300.
Potential substrates for and mechanisms of action for cardiac resynchronization therapy pacemakers (CRT‐P). Kaplan–Meier estimates for all‐cause mortality (hazard ratio 0.68, 95% confidence interval [CI] 0.56–0.81; p < 0.0001) and time to composite of first hospitalization for heart failure or all‐cause mortality (hazard ratio 0.67, 95% CI 0.58–0.78; p < 0.0001). No heterogeneity was identified in the effect of CRT‐P on mortality amongst trial participants. CRT‐P had greater effects on the composite outcome (hospitalization for heart failure or all‐cause mortality) for those taking beta‐blockers and patients of smaller stature. Although women are, on average, smaller than men, no interaction between CRT‐P and sex was observed. Similar trends were observed when only men were included in the analysis. These analyses suggest that stature rather than sex is associated with the effect of CRT‐P on outcome. LBBB, left bundle branch block.</description><subject>Adrenergic beta-Antagonists</subject><subject>Aged</subject><subject>Body surface area</subject><subject>Cardiac resynchronization therapy</subject><subject>Cardiac Resynchronization Therapy - methods</subject><subject>Defibrillators</subject><subject>Defibrillators, Implantable</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - epidemiology</subject><subject>Heart Failure - therapy</subject><subject>Humans</subject><subject>Individual patient data meta‐analysis</subject><subject>Male</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Sex</subject><subject>Stroke Volume</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><issn>1388-9842</issn><issn>1879-0844</issn><issn>1879-0844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kc1O3DAURi3Uqvy0C16g8rIsAo7tBKe70WimQ0WZqqLryLGvNUZJPLUdUFj1EXgFXo0nqcNQdqx8P92jY9kfQsc5Oc0JoWdwszGntKB8Dx3k4rzKiOD8XZqZEFklON1HhyHcEJKfJ_wD2mcFrwhj1QF6vN4ABmNARewMVtJrKxX2EMZebbzr7b2M1vX4zsaNGyKWWIOxjbdtK6PzOK065xurbRyx7PWUomxT-poitr22t1YPssXbJII-Yi2jxB1E-fT3QfayHYMN093z9Y-fs6uL9dWzZj77tUjAavkRvTeyDfDp5TxCv5eL6_kqu1x_u5jPLjPFSsKzhgIRpgDFQDVMgFA8V5rLUolcAOOkIlpTKKBgmkhWQKVLRbTJS05N-gp2hL7svFvv_gwQYt3ZoCA9swc3hJqWhaCMsWJCT3ao8i4ED6beettJP9Y5qadG6qmRemoksZ9ftEPTgX4l_1eQgLMdcGdbGN821Yvvq-Wz8h8muZnn</recordid><startdate>202206</startdate><enddate>202206</enddate><creator>Cleland, John G.F.</creator><creator>Bristow, Michael R.</creator><creator>Freemantle, Nicholas</creator><creator>Olshansky, Brian</creator><creator>Gras, Daniel</creator><creator>Saxon, Leslie</creator><creator>Tavazzi, Luigi</creator><creator>Boehmer, John</creator><creator>Ghio, Stefano</creator><creator>Feldman, Arthur M.</creator><creator>Daubert, Jean‐Claude</creator><creator>Mets, David</creator><general>John Wiley & Sons, Ltd</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202206</creationdate><title>The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF</title><author>Cleland, John G.F. ; Bristow, Michael R. ; Freemantle, Nicholas ; Olshansky, Brian ; Gras, Daniel ; Saxon, Leslie ; Tavazzi, Luigi ; Boehmer, John ; Ghio, Stefano ; Feldman, Arthur M. ; Daubert, Jean‐Claude ; Mets, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3604-b2e08f5ec3ecb38e8c41cd4a6c818e34090dd2e5e53d0a35e9d6c0df1642f3393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adrenergic beta-Antagonists</topic><topic>Aged</topic><topic>Body surface area</topic><topic>Cardiac resynchronization therapy</topic><topic>Cardiac Resynchronization Therapy - methods</topic><topic>Defibrillators</topic><topic>Defibrillators, Implantable</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - epidemiology</topic><topic>Heart Failure - therapy</topic><topic>Humans</topic><topic>Individual patient data meta‐analysis</topic><topic>Male</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Sex</topic><topic>Stroke Volume</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cleland, John G.F.</creatorcontrib><creatorcontrib>Bristow, Michael R.</creatorcontrib><creatorcontrib>Freemantle, Nicholas</creatorcontrib><creatorcontrib>Olshansky, Brian</creatorcontrib><creatorcontrib>Gras, Daniel</creatorcontrib><creatorcontrib>Saxon, Leslie</creatorcontrib><creatorcontrib>Tavazzi, Luigi</creatorcontrib><creatorcontrib>Boehmer, John</creatorcontrib><creatorcontrib>Ghio, Stefano</creatorcontrib><creatorcontrib>Feldman, Arthur M.</creatorcontrib><creatorcontrib>Daubert, Jean‐Claude</creatorcontrib><creatorcontrib>Mets, David</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of heart failure</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cleland, John G.F.</au><au>Bristow, Michael R.</au><au>Freemantle, Nicholas</au><au>Olshansky, Brian</au><au>Gras, Daniel</au><au>Saxon, Leslie</au><au>Tavazzi, Luigi</au><au>Boehmer, John</au><au>Ghio, Stefano</au><au>Feldman, Arthur M.</au><au>Daubert, Jean‐Claude</au><au>Mets, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF</atitle><jtitle>European journal of heart failure</jtitle><addtitle>Eur J Heart Fail</addtitle><date>2022-06</date><risdate>2022</risdate><volume>24</volume><issue>6</issue><spage>1080</spage><epage>1090</epage><pages>1080-1090</pages><issn>1388-9842</issn><issn>1879-0844</issn><eissn>1879-0844</eissn><abstract>Aims
Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. The aim of this study was to identify patient characteristics that predict the effect, specifically, of CRT pacemakers (CRT‐P) on all‐cause mortality or the composite of hospitalization for heart failure or all‐cause mortality.
Methods and results
We conducted an individual patient data meta‐analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization‐Heart Failure (CARE‐HF) trials. Only patients assigned to CRT‐P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. Median age was 67 (59–73) years, most patients were men (70%), 68% had a QRS duration of 150–199 ms and 80% had left bundle branch block. Patients assigned to CRT‐P had lower rates for all‐cause mortality (hazard ratio [HR] 0.68, 95% confidence interval [CI] 0.56–0.81; p < 0.0001) and the composite outcome (HR 0.67, 95% CI 0.58–0.78; p < 0.0001). No pre‐specified characteristic, including sex, aetiology of ventricular dysfunction, QRS duration (within the studied range) or morphology or PR interval significantly influenced the effect of CRT‐P on all‐cause mortality or the composite outcome. However, CRT‐P had a greater effect on the composite outcome for patients with lower body surface area and those prescribed beta‐blockers.
Conclusions
Cardiac resynchronization therapy‐pacemaker reduces morbidity and mortality in appropriately selected patients with heart failure. Benefits may be greater in smaller patients and in those receiving beta‐blockers. Neither QRS duration nor morphology independently predicted the benefit of CRT‐P.
Clinical Trial Registration: COMPANION, NCT00180258; CARE‐HF, NCT00170300.
Potential substrates for and mechanisms of action for cardiac resynchronization therapy pacemakers (CRT‐P). Kaplan–Meier estimates for all‐cause mortality (hazard ratio 0.68, 95% confidence interval [CI] 0.56–0.81; p < 0.0001) and time to composite of first hospitalization for heart failure or all‐cause mortality (hazard ratio 0.67, 95% CI 0.58–0.78; p < 0.0001). No heterogeneity was identified in the effect of CRT‐P on mortality amongst trial participants. CRT‐P had greater effects on the composite outcome (hospitalization for heart failure or all‐cause mortality) for those taking beta‐blockers and patients of smaller stature. Although women are, on average, smaller than men, no interaction between CRT‐P and sex was observed. Similar trends were observed when only men were included in the analysis. These analyses suggest that stature rather than sex is associated with the effect of CRT‐P on outcome. LBBB, left bundle branch block.</abstract><cop>Oxford, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>35490339</pmid><doi>10.1002/ejhf.2524</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European journal of heart failure, 2022-06, Vol.24 (6), p.1080-1090 |
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| subjects | Adrenergic beta-Antagonists Aged Body surface area Cardiac resynchronization therapy Cardiac Resynchronization Therapy - methods Defibrillators Defibrillators, Implantable Female Heart failure Heart Failure - epidemiology Heart Failure - therapy Humans Individual patient data meta‐analysis Male Morbidity Mortality Sex Stroke Volume Treatment Outcome Ventricular Function, Left |
| title | The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual patient data meta‐analysis of COMPANION and CARE‐HF |
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