Impact of cardiac resynchronization therapy on hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure trial

Anne M Gillis; Charles R Kerr; François Philippon; Gary Newton; Mario Talajic; Michael Froeschl; Sandra Froeschl; Elizabeth Swiggum; Elizabeth Yetisir; George A Wells; Anthony S Tang

doi:10.1161/CIRCULATIONAHA.112.000417

Impact of cardiac resynchronization therapy on hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure trial

Circulation. 2014 May 20;129(20):2021-30. doi: 10.1161/CIRCULATIONAHA.112.000417. Epub 2014 Mar 7.

Affiliations

¹ From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul's Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa, ON, Canada (S.F.); and Island Medical Program, University of British Columbia, Victoria, BC, Canada (E.S., A.S.T.). amgillis@ucalgary.ca.
² From the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada (A.M.B.); St. Paul's Hospital, Vancouver, BC, Canada (C.R.K.); Quebec Heart and Lung Institute, Sainte Foy, QC, Canada (F.P.); Mount Sinai Hospital, Toronto, ON, Canada (G.N.); Montreal Heart Institute and Université de Montreal, Montreal, QC, Canada (M.T.); University of Ottawa Heart Institute, Ottawa, ON, Canada (M.F., E.Y., G.A.W., A.S.T.); University of Ottawa, Ottawa, ON, Canada (S.F.); and Island Medical Program, University of British Columbia, Victoria, BC, Canada (E.S., A.S.T.).

PMID: 24610807
DOI: 10.1161/CIRCULATIONAHA.112.000417

Abstract

Background: This study reports the impact of cardiac resynchronization therapy (CRT) on hospitalizations in patients randomized to implantable cardioverter-defibrillator (ICD) or ICD-CRT in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT).

Methods and results: Hospitalization rates and lengths of hospital stay were compared between the 2 groups. At the 18-month follow-up, the numbers of patients hospitalized for any cause were similar in the ICD (n=351, 38.8%) and ICD-CRT (n=331, 30.0%) groups. The number of patients hospitalized for heart failure was significantly lower in the ICD-CRT (n=101, 11.3%) compared with the ICD (n=141, 15.6%; P=0.003) group. The number of patients hospitalized for a device-related indication was similar in the ICD-CRT group (n=147, 16.4%) and ICD group (n=126, 13.9%; P=0.148). The total number of hospitalizations for any cause (n=1448 versus n=1553; P=0.042), any cardiovascular cause (n=667 versus n=790; P=0.017), and any heart failure cause (n=385 versus n=505; P<0.0001) was significantly lower in ICD-CRT group compared with the ICD group, whereas the number of hospitalizations for device-related causes was significantly higher in the ICD-CRT group compared with the ICD group (246 versus 159; P<0.001). Although the reduction in hospitalizations for heart failure in the CRT-ICD group was offset by an increased number of hospitalizations for device-related indications, the length of hospital stay for any cause was significantly shorter in the ICD-CRT group (8.83±13.30 days) compared with the ICD group (9.59±14.40 days; P=0.005).

Conclusion: ICD-CRT therapy significantly reduces hospitalizations and total days in hospital in patients with New York Heart Association class II/III heart failure compared with ICD therapy despite increased admissions for device-related indications.

Clinical trial registration url: http://www.clinicaltrials.gov. Unique identifier: NCT00251251.

Keywords: cardiac resynchronization therapy; heart failure; hospitalization.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cardiac Resynchronization Therapy / methods*
Defibrillators, Implantable*
Female
Follow-Up Studies
Heart Failure / mortality
Heart Failure / therapy*
Hospitalization / statistics & numerical data*
Humans
Kaplan-Meier Estimate
Length of Stay / statistics & numerical data*
Male
Middle Aged
Patient Readmission / statistics & numerical data*
Proportional Hazards Models
Risk Factors
Secondary Prevention

Associated data

ClinicalTrials.gov/NCT00251251

Grants and funding

Canadian Institutes of Health Research/Canada