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. 2019 May 1;21(5):754-762.
doi: 10.1093/europace/euy267.

Survival after cardiac resynchronization therapy: results from 50 084 implantations

Francisco Leyva  1 , Abbasin Zegard  1 , Osita Okafor  1 , Joseph de Bono  2 , David McNulty  2 , Asif Ahmed  1 , Howard Marshall  2 , Daniel Ray  3 , Tian Qiu  2
Affiliations

Survival after cardiac resynchronization therapy: results from 50 084 implantations

Francisco Leyva et al. Europace. .

Abstract

Aims: Randomized controlled trials have shown that cardiac resynchronization therapy (CRT) prolongs survival in patients with heart failure. No studies have explored survival after CRT in relation to individuals in the general population (relative survival, RS). We sought to determine observed and RS after CRT in a nationwide cohort undergoing CRT.

Methods and results: A national administrative database was used to quantify observed mortality for patients undergoing CRT. Relative survival (RS) was quantified using life tables. In 50 084 patients [age 72.1 ± 11.6 years (mean ± standard deviation)] undergoing CRT with (CRT-D) (n = 25 273) or without (CRT-P) defibrillation (n = 24 811) over 8.8 years (median follow-up 2.7 years, interquartile range 1.3-4.8), expected survival decreased with age. Device type, male sex, ischaemic heart disease, diabetes, and chronic kidney disease predicted excess mortality. In multivariate analyses, excess mortality (analogue of RS) was lower after CRT-D than after CRT-P in all patients [adjusted hazard ratio (aHR) 0.80, 95% confidence interval (CI) 0.76-0.84] as well as in subgroups with (aHR 0.79, 95% CI 0.74-0.84) or without (aHR 0.82, 95% CI 0.74-0.91) ischaemic heart disease. A Charlson Comorbidity Index (CCI) ≥3 portended a higher excess mortality (aHR 3.04, 95% CI 2.76-3.34). Relative survival was higher in 2015-2017 than in 2009-2011 (aHR 0.64, 95% CI 0.59-0.69).

Conclusion: Reference RS data after CRT is presented. Sex, ischaemic heart disease, diabetes, chronic kidney disease, and CCI were major determinants of RS after CRT. CRT-D was associated with a higher RS than CRT-P in patients with or without ischaemic heart disease. Relative survival after CRT improved from 2009 to 2017.

Keywords: Cardiac resynchronization therapy; Implantable cardioverter-defibrillator; Mortality; Relative survival.

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Figures

Figure 1
Figure 1
Study flowchart. CRT, cardiac resynchronization therapy.
Figure 2
Figure 2
Implant rates in England. (A) The distribution of CRT implantations in England, in the period 2009–2017 is shown. Size and colour of circles are proportional to implant rates. (B) The number of CRT implantations over the study period is shown. Results are presented as number of implants per year. The year 2017 is not shown as data only extends to September. CRT, cardiac resynchronization therapy.
Figure 3
Figure 3
Expected survival after CRT compared with the general population. (A) Expected survival after CRT-D (solid green) or CRT-P (solid blue line) relative to the life expectancy in the general population in England (solid blue line), for the period 2015–2017 is shown. (B) The effect of comorbidity, defined in terms of the CCI is shown. For detailed calculations, see Supplementary material online, Appendix. CRT, cardiac resynchronization therapy.
Figure 4
Figure 4
Observed and expected survival: subgroup analyses. Observed and excess mortality after CRT-D and CRT-P in subgroups, expressed in terms of HRs and EHRs, respectively. CCI, Charlson Comorbidity Index; CRT, cardiac resynchronization therapy; EHR, excess hazard ratios; HR, hazard ratio.
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Comment in

References

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