PMID- 34486653
OWN - NLM
STAT- MEDLINE
DCOM- 20220330
LR  - 20220531
IS  - 1532-2092 (Electronic)
IS  - 1099-5129 (Print)
IS  - 1099-5129 (Linking)
VI  - 24
IP  - 1
DP  - 2022 Jan 4
TI  - Cardiac resynchronization therapy with or without defibrillator in patients with 
      heart failure.
PG  - 48-57
LID - 10.1093/europace/euab233 [doi]
AB  - 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.
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Schrage, Benedikt
AU  - Schrage B
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, SE-17176 
      Stockholm, Sweden.
AD  - Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, 
      Germany & German Center for Cardiovascular Research, partner site 
      Hamburg/Kiel/Lubeck, Hamburg, Germany.
FAU - Lund, Lars H
AU  - Lund LH
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, SE-17176 
      Stockholm, Sweden.
AD  - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
FAU - Melin, Michael
AU  - Melin M
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, SE-17176 
      Stockholm, Sweden.
AD  - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
FAU - Benson, Lina
AU  - Benson L
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, SE-17176 
      Stockholm, Sweden.
FAU - Uijl, Alicia
AU  - Uijl A
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, SE-17176 
      Stockholm, Sweden.
AD  - Julius Center for Health Sciences and Primary Care, University Medical Center 
      Utrecht, Utrecht University, The Netherlands.
FAU - Dahlstrom, Ulf
AU  - Dahlstrom U
AD  - Department of Cardiology, Linkoping University, Linkoping, Sweden.
AD  - Department of Health, Medicine and Caring Sciences, Linkoping University, 
      Linkoping, Sweden.
FAU - Braunschweig, Frieder
AU  - Braunschweig F
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, SE-17176 
      Stockholm, Sweden.
AD  - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
FAU - Linde, Cecilia
AU  - Linde C
AUID- ORCID: 0000-0002-9039-6023
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, SE-17176 
      Stockholm, Sweden.
AD  - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
FAU - Savarese, Gianluigi
AU  - Savarese G
AUID- ORCID: 0000-0001-7732-0887
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, SE-17176 
      Stockholm, Sweden.
AD  - Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
SB  - IM
MH  - Aged
MH  - *Cardiac Resynchronization Therapy/methods
MH  - *Defibrillators, Implantable/statistics & numerical data
MH  - Female
MH  - *Heart Failure/therapy
MH  - Humans
MH  - Male
MH  - Risk Factors
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/therapy
PMC - PMC8742627
OTO - NOTNLM
OT  - Cardiac resynchronization therapy
OT  - Heart failure
OT  - Heart failure with reduced ejection fraction
OT  - Implantable cardioverter-defibrillator
OT  - Primary prevention
OT  - Swedish Heart Failure Registry
EDAT- 2021/09/07 06:00
MHDA- 2022/03/31 06:00
PMCR- 2021/09/06
CRDT- 2021/09/06 09:43
PHST- 2021/03/28 00:00 [received]
PHST- 2021/08/19 00:00 [accepted]
PHST- 2021/09/07 06:00 [pubmed]
PHST- 2022/03/31 06:00 [medline]
PHST- 2021/09/06 09:43 [entrez]
PHST- 2021/09/06 00:00 [pmc-release]
AID - 6364844 [pii]
AID - euab233 [pii]
AID - 10.1093/europace/euab233 [doi]
PST - ppublish
SO  - Europace. 2022 Jan 4;24(1):48-57. doi: 10.1093/europace/euab233.