Mode of death in advanced heart failure: the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial.
OBJECTIVE
The aim of this study was to evaluate the mode of death in patients with advanced chronic heart failure (HF) and intraventricular conduction delay treated with optimal pharmacologic therapy (OPT) alone or OPT with biventricular pacing to provide cardiac resynchronization therapy (CRT) or CRT + an implantable defibrillator (CRT-D).


BACKGROUND
Limited data are available on mode of death in advanced HF. No data have existed on mode of death in these patients who also have an intraventricular conduction delay and are treated with CRT or CRT-D.


METHODS
Using prespecified definitions and source materials, seven cardiologists assessed mode of death among the 313 deaths that occurred in the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial.


RESULTS
A primary cardiac cause was present in 78% of deaths. Pump failure (44.4%) was the most common mode of death followed by sudden cardiac death (SCD) (26.5%). Compared with OPT, CRT-D significantly reduced the number of cardiac deaths (38%, p = 0.006), whereas CRT alone was associated with a non-significant 14.5% reduction (p = 0.33). Both CRT and CRT-D tended to reduce pump failure deaths (29%, p = 0.11 and 27%, p = 0.14, respectively). The CRT-D significantly reduced SCD (56%, p = 0.02), but CRT alone did not.


CONCLUSIONS
Pump failure deaths are the predominant mode of death in patients with advanced HF and are modestly reduced by both CRT and CRT-D. Only CRT-D reduced SCD and thus produced a favorable effect on cardiac mortality.
Carson
Peter
P
Division of Cardiology, Veterans Affairs Medical Center, Washington, DC 20422, USA. Peter.Carson@med.va.gov
Anand
Inder
I
O'Connor
Christopher
C
Jaski
Brian
B
Steinberg
Jonathan
J
Lwin
Amy
A
Lindenfeld
JoAnn
J
Ghali
Jalal
J
Ghali
Jalil
J
Barnet
Jodi H
JH
Feldman
Arthur M
AM
Bristow
Michael R
MR
D002303:Cardiac Output, Low / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002423:Cause of Death; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D004554:Electric Countershock; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016019:Survival Analysis
D002316:Cardiotonic Agents