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. 2022 Apr 2;3(4):405-414.
doi: 10.1016/j.hroo.2022.03.004. eCollection 2022 Aug.

Temporal trends and long-term outcomes among recipients of cardiac resynchronization therapy with defibrillator in the United States, 2011-2015: Insights from the National Cardiovascular Data Registry

Douglas Darden  1 , Pamela N Peterson  2   3 , Xin Xin  4 , Muhammad Bilal Munir  1 , Karl E Minges  4   5 , Ilan Goldenberg  6   7 , Jeanne E Poole  8 , Gregory K Feld  1 , Ulrika Birgersdotter-Green  1 , Jeptha P Curtis  4   5 , Jonathan C Hsu  1
Affiliations

Temporal trends and long-term outcomes among recipients of cardiac resynchronization therapy with defibrillator in the United States, 2011-2015: Insights from the National Cardiovascular Data Registry

Douglas Darden et al. Heart Rhythm O2. .

Abstract

Background: Contemporary data on national trends and outcomes in cardiac resynchronization therapy with defibrillator (CRT-D) recipients following the 2012 updated guidelines has not been studied.

Objectives: This study assessed the trends in long-term outcomes among CRT-D Medicare-aged recipients implanted in 2011-2015.

Methods: Patients aged ≥65 years undergoing de novo CRT-D implantation in the National Cardiovascular Data Implantable Cardiac Defibrillator Registry from 2011-2015 with follow-up through 2017 using Medicare data were included and stratified by year of implant. Patient characteristics, in-hospital outcomes, and outcomes up to 2 years following implant were evaluated.

Results: Among 53,174 patients (aged 75.6-6.4 years, 29.7% women) implanted with CRT-D from 2011 to 2015, there was an increase in implantations based on guideline-concordant recommendations (81.0% to 84.7%, P < .001). Compared to 2011, in-hospital procedural complications decreased in 2015 (3.9% vs 2.9%; adjusted odds ratio, 0.76, 95% confidence interval, 0.66-0.88, P < .001), driven in part by decreased lead dislodgement (1.4% vs 1.0%). After multivariable adjustment, there was a lower risk of all-cause hospitalization, cardiovascular hospitalization, and mortality at 2-year follow-up in 2015 as compared to 2011, while there were no differences in heart failure hospitalizations at follow-up.

Conclusion: Among Medicare beneficiaries receiving CRT-D from 2011 to 2015, there was an increase in implantations based on guideline-concordant recommendations. Furthermore, there has been a reduction in in-hospital complications and long-term outcomes, including cardiovascular hospitalization, all-cause hospitalization, and mortality; however, there has been no difference in the risk of heart failure hospitalization after adjustment.

Keywords: Cardiac resynchronization therapy; Implantable cardiac defibrillator; Outcomes research; Registries; Trends.

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Figures

Figure 1
Figure 1
Unadjusted and adjusted long-term outcomes in year 2015 as compared to 2011 (reference) among cardiac resynchronization therapy defibrillator recipients: A: mortality; B: all-cause hospitalization; C: cardiovascular hospitalization; and D: heart failure hospitalization.
See this image and copyright information in PMC

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