Heart Failure
Temporal Influence of Heart Failure Hospitalizations Prior to Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy With Defibrillator on Subsequent Outcome in Mild Heart Failure Patients (from MADIT-CRT)

https://doi.org/10.1016/j.amjcard.2015.02.029Get rights and content

The temporal effect of heart failure (HF) hospitalization occurring at different time periods before implantation has not yet been studied in detail. The aim of the present study was to investigate the potential association between time from last HF hospitalization to device implantation and effects on subsequent outcomes and benefit from cardiac resynchronization therapy with a defibrillator (CRT-D). Multivariate Cox models were used to determine the temporal influence of previous HF hospitalization on the end point of HF or death within all left bundle branch block implantable cardioverter-defibrillator (ICD) and CRT-D patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT) trial (n = 1,250) and to evaluate the clinical benefit of CRT-D implantation, comparing CRT-D patients with ICD patients within each previous HF hospitalization group. The patients with previous HF hospitalization ≤12 months before device implantation had the greatest incidence of HF or death during 4-year follow-up (31%), while those with previous HF hospitalization >12 months and those with no previous HF hospitalization had similar lower rates of HF or death (22% and 24%, respectively). All patients treated with CRT-D derived significant clinical benefit compared with their ICD counterparts, regardless of time of previous hospitalization (hazard ratios 0.38 [no previous hospitalization], 0.49 (≤12 months), and 0.45 (>12 months); p for interaction = 0.67). In conclusion, in the present study of patients with mild HF with prolonged QRS intervals and LBBB, a previous HF hospitalization ≤12 months was associated with increased risk for HF or death compared with >12 months and no previous HF hospitalizations. The clinical benefit of CRT-D was evident in all patients regardless of time from last HF hospitalization to implantation compared with ICD only.

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Methods

The design, protocol, and results of MADIT-CRT have previously been published.2, 10 Briefly, MADIT-CRT was a randomized, multicenter trial designed to determine the possible benefit of implanting a CRT-D device compared with an implantable cardioverter-defibrillator (ICD) in patients with mild HF, prolonged QRS duration and depressed left ventricular ejection fractions. From December 22, 2004, through June 24, 2009, the trial enrolled 1,820 patients from 110 different centers in the United

Results

Of 1,820 patients in the original MADIT-CRT trial, 1,250 (68.7%) had LBBB QRS morphology, with 746 patients treated with CRT-D and 504 with ICDs. The baseline characteristics of the 1,250 patients with LBBB subcategorized into no previous HF hospitalization (n = 774), previous HF hospitalization ≤12 months (n = 253), and previous HF hospitalization ≥12 months (n = 253) before CRT-D implantation are listed in Table 1. In general, the group with previous HF hospitalization within 12 months before

Discussion

In this substudy of MADIT-CRT involving patients with mild HF with LBBB QRS morphology, we found an increased risk for HF or death associated with a recent HF hospitalization ≤12 months before device implantation compared with patients with no previous HF hospitalization and those with previous HF hospitalization >12 months. All 3 groups derived similar and significant CRT-D benefit compared with ICD-treated patients, irrespective of previous HF hospitalizations and time from previous HF

Disclosures

Dr. Zareba and Dr. Moss have received grant support from Boston Scientific. Dr. Ruwald was a Mirowski-Moss Awardee and has received unrestricted travel grants from the Denmark-America Foundation, Falck Denmark, The Lundbeck-Foundation, Bønnelykkefonden, Carl and Ellen Hertz Grant, and Torben and Alice Frimodts Foundation.

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The MADIT-CRT study was supported by a research grant from Boston Scientific, Natick, Massachusetts, to the University of Rochester, with funds distributed to the coordination and data center, enrolling centers, core laboratories, committees, and boards under subcontracts from the University of Rochester. ClinicalTrials.gov identifier NCT00180271.

See page 1427 for disclosure information.

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