The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual-patient-data meta-analysis of COMPANION and CARE-HF

Cleland, J. G.F. et al. (2022) The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: an individual-patient-data meta-analysis of COMPANION and CARE-HF. European Journal of Heart Failure, 24(6), pp. 1080-1090. (doi: 10.1002/ejhf.2524) (PMID:35490339) (PMCID:PMC9543287)

Abstract

Background: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality for patients with heart failure, reduced left ventricular ejection fraction, QRS duration >130 ms and in sinus rhythm. Objectives: To identify patient-characteristics that predict the effect, specifically, of CRT-pacemakers (CRT-P) on all-cause mortality or the composite of hospitalisation for heart failure or all-cause mortality. Methods: An individual patient-data meta-analysis of the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) and Cardiac Resynchronization – Heart Failure (CARE-HF) trials. Only patients assigned to CRT-P or control (n = 1738) were included in order to avoid confounding from concomitant defibrillator therapy. The influence of baseline characteristics on treatment effects was investigated. Results: Median age was 67 (59–73) years, most patients were men (70%), 68% had a QRS duration of 150-199 ms and 80% had left bundle branch block (LBBB). Patients assigned to CRT-P had lower rates for all-cause mortality (HR 0.68 (95% CI 0.56 to 0.81; p < 0.0001) and the composite outcome (HR 0.67 (95% CI 0.58 to 0.78; p < 0.0001). No pre-specified characteristic, including sex, aetiology of ventricular dysfunction, QRS duration (within the studied range) or morphology or PR interval significantly influenced the effect of CRT-P on all-cause mortality or the composite outcome. However, CRT-P had a greater effect on the composite outcome for patients with lower body surface area (BSA) and those prescribed beta-blockers. Conclusions: CRT-P reduces morbidity and mortality in appropriately selected patients with heart failure. Benefits may be greater in smaller patients and in those receiving beta-blockers. Neither QRS duration nor morphology independently predicted the benefit of CRT-P.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Cleland, J. G.F., Bristow, M. R., Freemantle, N., Olshansk, B., Gras, D., Saxon, L., Tavazzi, L., Boehmer, J., Ghio, S., Feldman, A. M., Daubert, J.-C., and deMets, D.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 01 May 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in European Journal of Heart Failure 24(6): 1080-1090
• Publisher Policy: Reproduced under a Creative Commons License

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303944		BHF Centre of Excellence	Colin Berry	British Heart Foundation (BHF)	RE/18/6/34217	CAMS - Cardiovascular Science