PMID- 21320922
OWN - NLM
STAT- MEDLINE
DCOM- 20110526
LR  - 20201216
IS  - 1539-3704 (Electronic)
IS  - 0003-4819 (Linking)
VI  - 154
IP  - 6
DP  - 2011 Mar 15
TI  - Meta-analysis: cardiac resynchronization therapy for patients with less 
      symptomatic heart failure.
PG  - 401-12
LID - 10.7326/0003-4819-154-6-201103150-00313 [doi]
AB  - BACKGROUND: Cardiac resynchronization therapy (CRT) reduces morbidity and 
      mortality in patients with advanced symptoms of heart failure. PURPOSE: To assess 
      the benefits and harms of CRT in patients with advanced heart failure and those 
      with less symptomatic disease. DATA SOURCES: A search of electronic databases 
      (1950 to December 2010), hand-searching of reference lists, and unpublished data 
      from principal investigators. Searches were not limited to the English language. 
      STUDY SELECTION: Randomized, controlled trials of CRT compared with usual care 
      and right or left ventricular pacing in adults with heart failure and a left 
      ventricular ejection fraction of 0.40 or less. DATA EXTRACTION: Two reviewers 
      performed independent study selection, data abstraction, and quality assessment 
      by using the Cochrane tool for assessing risk for bias. DATA SYNTHESIS: There 
      were 9082 patients in 25 trials. In patients with New York Heart Association 
      (NYHA) class I and II symptoms, CRT reduced all-cause mortality (6 trials, 4572 
      participants; risk ratio [RR], 0.83 [95% CI, 0.72 to 0.96]) and heart failure 
      hospitalizations (4 trials, 4349 participants; RR, 0.71 [CI, 0.57 to 0.87]) 
      without improving functional outcomes or quality of life. In patients with NYHA 
      class III or IV symptoms, CRT improved functional outcomes and reduced both 
      all-cause mortality (19 trials, 4510 participants; RR, 0.78 [CI, 0.67 to 0.91]) 
      and heart failure hospitalizations (11 trials, 2663 participants; RR, 0.65 [CI, 
      0.50 to 0.86]). The implant success rate was 94.4%; peri-implantation deaths 
      occurred in 0.3% of trial participants, mechanical complications in 3.2%, lead 
      problems in 6.2%, and infections in 1.4%. LIMITATION: Subgroup analyses were 
      underpowered and lack data for persons with NYHA class I symptoms, atrial 
      fibrillation, chronic kidney disease, or right bundle branch block. CONCLUSION: 
      Cardiac resynchronization therapy is beneficial for patients with reduced left 
      ventricular ejection fraction, symptoms of heart failure, and prolonged QRS, 
      regardless of NYHA class. PRIMARY FUNDING SOURCE: None.
FAU - Al-Majed, Nawaf S
AU  - Al-Majed NS
AD  - Mazankowski Alberta Heart Institute, University of Alberta, Canada.
FAU - McAlister, Finlay A
AU  - McAlister FA
FAU - Bakal, Jeffrey A
AU  - Bakal JA
FAU - Ezekowitz, Justin A
AU  - Ezekowitz JA
LA  - eng
GR  - Canadian Institutes of Health Research/Canada
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
DEP - 20110214
PL  - United States
TA  - Ann Intern Med
JT  - Annals of internal medicine
JID - 0372351
SB  - IM
CIN - Ann Intern Med. 2011 Mar 15;154(6):436-8. PMID: 21320924
CIN - Ann Intern Med. 2011 Aug 16;155(4):JC2-7. PMID: 21844540
MH  - Aged
MH  - *Cardiac Resynchronization Therapy/adverse effects
MH  - Cause of Death
MH  - Electrocardiography
MH  - Heart Failure/mortality/physiopathology/*therapy
MH  - Hospitalization
MH  - Humans
MH  - Middle Aged
MH  - Publication Bias
MH  - Quality of Life
MH  - Ventricular Dysfunction, Left/physiopathology
EDAT- 2011/02/16 06:00
MHDA- 2011/05/27 06:00
CRDT- 2011/02/16 06:00
PHST- 2011/02/16 06:00 [entrez]
PHST- 2011/02/16 06:00 [pubmed]
PHST- 2011/05/27 06:00 [medline]
AID - 0003-4819-154-6-201103150-00313 [pii]
AID - 10.7326/0003-4819-154-6-201103150-00313 [doi]
PST - ppublish
SO  - Ann Intern Med. 2011 Mar 15;154(6):401-12. doi: 
      10.7326/0003-4819-154-6-201103150-00313. Epub 2011 Feb 14.