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Cardiac resynchroni...
Cardiac resynchronization therapy with or without defibrillator in patients with heart failure
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- Schrage, Benedikt (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Univ Heart & Vasc Ctr Hamburg, Germany; German Ctr Cardiovasc Res, Germany
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- Lund, Lars H. (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Melin, Michael (författare)
- Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Benson, Lina (författare)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Uijl, Alicia (författare)
- Karolinska Inst, Sweden; Univ Utrecht, Netherlands
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- Dahlström, Ulf (författare)
- Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Braunschweig, Frieder (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Linde, Cecilia (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Savarese, Gianluigi (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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(creator_code:org_t)
- 2021-09-06
- 2022
- Engelska.
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Ingår i: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 24:1, s. 48-57
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https://academic.oup...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Aims Randomized data on the efficacy/safety of cardiac resynchronization therapy with vs. without defibrillator (CRT-D,-P) in heart failure with reduced ejection fraction (HFrEF) are scarce. We aimed to evaluate survival associated with use of CRT-D vs. CRT-P in a contemporary cohort with HFrEF. Methods and results Patients from Swedish HF Registry treated with CRT-D/CRT-P and fulfilling criteria for primary prevention defibrillator use were included. Logistic regression was used to evaluate predictors of CRT-D non-use. All-cause mortality was compared in CRT-D vs. CRT-P by Cox regression in a 1 : 1 propensity-score-matched cohort. Of 1988 patients with CRT, 1108 (56%) had CRT-D and 880 (44%) CRT-P. Older age, higher ejection fraction (EF), female sex, and the lack of referral to HF nurse-led outpatient clinic were major determinants of CRT-D non-use. After matching, 645 CRT-D patients were compared with 645 with CRT-P. The CRT-D use was associated with lower 1- and 3-year all-cause mortality [hazard ratio (HR):0.76, 95% confidence interval (CI):0.58-0.98; HR: 0.82, 95% CI: 0.68-0.99, respectively]. Results were consistent in all pre-specified subgroups except for CRT-D use being associated with lower 3-year mortality in patients with an EF < 30% but not in those with an EF >= 30% (HR: 0.73, 95% CI: 0.59-0.89 and HR: 1.24, 95% CI: 0.83-1.85, respectively; P-interaction = 0.02). Conclusion In a contemporary HFrEF cohort, CRT-D was associated with lower mortality compared with CRT-P. The CRT-D use was less likely in older patients, females, and in patients not referred to HF nurse-led outpatient clinic. Our findings support the use of CRT-D vs. CRT-P in HFrEF, in particular with severely reduced EF.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- Heart failure; Heart failure with reduced ejection fraction; Implantable cardioverter-defibrillator; Cardiac resynchronization therapy; Primary prevention; Swedish Heart Failure Registry
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Europace
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