PMID- 17190867
OWN - NLM
STAT- MEDLINE
DCOM- 20070205
LR  - 20220408
IS  - 1524-4539 (Electronic)
IS  - 0009-7322 (Linking)
VI  - 115
IP  - 2
DP  - 2007 Jan 16
TI  - Effects of cardiac resynchronization therapy with or without a defibrillator on 
      survival and hospitalizations in patients with New York Heart Association class 
      IV heart failure.
PG  - 204-12
AB  - BACKGROUND: Cardiac resynchronization therapy (CRT) alone or combined with an 
      implantable defibrillator (CRT-D) has been shown to improve exercise capacity and 
      quality of life and to reduce heart failure (HF) hospitalizations and mortality 
      in patients with New York Heart Association (NYHA) class III and IV HF. There is 
      concern that the device procedure may destabilize these very ill class IV 
      patients. We sought to examine the outcomes of NYHA class IV patients enrolled in 
      the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure 
      (COMPANION) trial to assess the potential benefits of CRT and CRT-D. METHODS AND 
      RESULTS: The COMPANION trial randomized 1520 patients with NYHA class III and IV 
      HF to optimal medical therapy, CRT, or CRT-D. In the class IV patients (n=217), 
      the primary end point of time to death or hospitalization for any cause was 
      significantly improved by both CRT (hazard ratio [HR], 0.64; 95% CI, 0.43 to 
      0.94; P=0.02) and CRT-D (HR, 0.62; 95% CI, 0.42 to 0.90; P=0.01). Time to 
      all-cause death and HF hospitalization was also significantly improved in both 
      CRT (HR, 0.57; 95% CI, 0.37 to 0.87; P=0.01) and CRT-D (HR, 0.49; 95% CI, 0.32 to 
      0.75; P=0.001) Time to all-cause death trended to an improvement in both CRT (HR, 
      0.67; 95% CI, 0.41 to 1.10; P=0.11) and CRT-D (HR, 0.63; 95% CI, 0.39 to 1.03; 
      P=0.06). Time to sudden death appeared to be significantly reduced in the CRT-D 
      group (HR, 0.27; 95% CI, 0.08 to 0.90; P=0.03). There was a nonsignificant 
      reduction in time to HF deaths for both CRT (HR, 0.68; 95% CI, 0.34 to 1.37; 
      P=0.28) and CRT-D (HR, 0.79; 95% CI, 0.41 to 1.52; P=0.48). CONCLUSIONS: CRT and 
      CRT-D significantly improve time to all-cause mortality and hospitalizations in 
      NYHA class IV patients, with a trend for improved mortality. These devices should 
      be considered in ambulatory NYHA class IV HF patients similar to those enrolled 
      in COMPANION.
FAU - Lindenfeld, JoAnn
AU  - Lindenfeld J
AD  - Department of Medicine, University of Colorado Health Sciences Center, 4200 E. 
      Ninth Ave, Denver, CO 80262, USA. joann.lindenfeld@uchsc.edu
FAU - Feldman, Arthur M
AU  - Feldman AM
FAU - Saxon, Leslie
AU  - Saxon L
FAU - Boehmer, John
AU  - Boehmer J
FAU - Carson, Peter
AU  - Carson P
FAU - Ghali, Jalal K
AU  - Ghali JK
FAU - Anand, Inder
AU  - Anand I
FAU - Singh, Steve
AU  - Singh S
FAU - Steinberg, Jonathan S
AU  - Steinberg JS
FAU - Jaski, Brian
AU  - Jaski B
FAU - DeMarco, Teresa
AU  - DeMarco T
FAU - Mann, David
AU  - Mann D
FAU - Yong, Patrick
AU  - Yong P
FAU - Galle, Elizabeth
AU  - Galle E
FAU - Ecklund, Fred
AU  - Ecklund F
FAU - Bristow, Michael
AU  - Bristow M
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
DEP - 20061226
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
CIN - Circulation. 2007 Jan 16;115(2):161-2. PMID: 17228011
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiac Pacing, Artificial/methods/*mortality
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Heart Failure/*classification/*mortality/therapy
MH  - Hospital Mortality
MH  - *Hospitalization
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - New York
MH  - Survival Rate
EDAT- 2006/12/28 09:00
MHDA- 2007/02/06 09:00
CRDT- 2006/12/28 09:00
PHST- 2006/12/28 09:00 [pubmed]
PHST- 2007/02/06 09:00 [medline]
PHST- 2006/12/28 09:00 [entrez]
AID - CIRCULATIONAHA.106.629261 [pii]
AID - 10.1161/CIRCULATIONAHA.106.629261 [doi]
PST - ppublish
SO  - Circulation. 2007 Jan 16;115(2):204-12. doi: 10.1161/CIRCULATIONAHA.106.629261. 
      Epub 2006 Dec 26.