Impact of Cardiac Resynchronization Therapy on Hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial
What was the impact of cardiac resynchronization therapy (CRT) on hospitalizations in patients randomized to implantable cardioverter-defibrillator (ICD) or ICD-CRT in the RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) study?
In the RAFT study, patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more or a paced QRS duration of 200 msec or more, were randomized to receive either an ICD alone or an ICD plus CRT. In this prespecified analysis, the causes of hospitalization, hospitalization rates, and lengths of hospital stay were compared between the two groups.
At the 18-month follow-up, the number of patients hospitalized for any cause was similar in the ICD (n = 351, 38.8%) and ICD-CRT (n = 331, 30.0%) groups. The number of patients hospitalized for heart failure was significantly lower in the ICD-CRT (n = 101, 11.3%) compared with the ICD (n = 141, 15.6%; p = 0.003) group. The number of patients hospitalized for a device-related indication was similar in the ICD-CRT group (n = 147, 16.4%) and ICD group (n = 126, 13.9%; p = 0.148). The total number of hospitalizations for any cause (n = 1,448 vs. n = 1,553; p = 0.042), any cardiovascular cause (n = 667 vs. n = 790; p = 0.017), and any heart failure cause (n = 385 vs. n = 505; p < 0.0001) was significantly lower in the ICD-CRT group compared with the ICD group, whereas the number of hospitalizations for device-related causes was significantly higher in the ICD-CRT group compared with the ICD group (246 vs. 159; p < 0.001). Although the reduction in hospitalizations for heart failure in the CRT-ICD group was offset by an increased number of hospitalizations for device-related indications, the length of hospital stay for any cause was significantly shorter in the ICD-CRT group (8.83 ± 13.30 days) compared with the ICD group (9.59 ± 14.40 days; p = 0.005).
The authors concluded that ICD-CRT therapy significantly reduces hospitalizations and total days in the hospital in patients with New York Heart Association class II/III heart failure compared with ICD therapy despite increased admissions for device-related indications.
This study provides further evidence of the benefits of CRT in patients with severe LV dysfunction, wide QRS, and mild to moderate heart failure. Device-related admissions were not infrequent in both groups, in part due to Sprint Fidelis advisory-related issues, but they were significantly higher in patients with CRT-ICD than ICD alone. Despite this downside, the overall number of hospitalizations was fewer, and hospital stay was shorter in CRT-ICD group. This should translate into cost savings.
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