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CARDIAC RESYNCHRONIZATION THERAPY BENEFIT HOLDS UP IN CLINICAL PRACTICE
The benefit of cardiac resynchronization therapy with a defibrillator (CRT-D) relative to implantable cardioverter-defibrillator (ICD) therapy alone has not been evaluated in routine clinical practice. This study used data from the National Cardiovascular Data Registry's ICD Registry linked with Medicare claims data to compare outcomes after CRT-D and ICD implantation in community practice. The analysis included 7090 propensity matched patients who underwent either CRT-D or ICD implantation between 2006 and 2009 at one of 780 US hospitals participating in the NCDR ICD registry. Patients were over age 65 and met criteria for CRT-D implantation (left ventricular ejection fraction ≤35% and QRS duration ≥120 ms). Over 3 years of follow-up, CRT-D was associated with lower risk of mortality (HR 0.82, 99% CI 0.73–0.93), all-cause readmission (HR 0.86, 99% CI 0.81–0.93), and heart failure readmission (HR 0.78, 99% CI 0.69–0.88) compared with ICD therapy. However, CRT-D was also associated with a higher risk of device related infection (HR 1.90, 99% CI 1.07–3.37). In subgroup analyses, the reduced risk of heart failure readmission was most prominent …
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