title: Mortality of heart failure patients after cardiac resynchronization therapy: identification of predictors.
abstract: BACKGROUND
  A direct comparison of survival benefits between cardiac resynchronization therapy-pacemaker (CRT-P) and defibrillator (CRT-D) was not yet performed, leaving clinicians to question whether CRT-P alone is enough to protect congestive heart failure (CHF) patients from sudden cardiac death and whether CRT-D should be implanted to all CHF patients indicated for biventricular pacing. This study attempts to make this type of comparison in a large CHF population and seeks to identify predictors of death in patients with different comorbidities.
  
  
  RESULTS
  Study population consisted of 542 consecutive patients who were implanted with either CRT-P (N = 147) or CRT-D (N = 395) between 1999 and 2005. Patients' clinical and follow-up data were entered in a prospective registry and retrieved for analysis. The primary endpoint of this study was all-cause mortality during follow-up. Total all-cause mortality was significantly lower among patients with CRT-D (18.5% vs. 38.8% of CRT-P, chi(2)= 25.11, P < 0.001). Patients with one of three comorbidities--chronic renal failure (OR = 4.885, P = 0.005), diabetes mellitus (OR = 4.130, P = 0.003), and history of atrial fibrillation (OR = 1.473, P = 0.036)--appeared to have higher risk of death, while treatment with beta-blocker (OR = 0.330, P = 0.002) or CRT-D device (OR = 0.334, P = 0.003) seemed to be associated with lower mortality.
  
  
  CONCLUSIONS
  Data from this nonrandomized study indicate that CRT-D has additional survival benefits over CRT-P. Given these findings, CRT-D should be recommended to most CHF patients with indications for biventricular pacing. After CRT implant, chronic renal failure, diabetes mellitus, and history of atrial fibrillation are strong independent predictors of death.
authors.affiliation: Department of Cardiovascular Medicine, Section of Cardiac Electrophysiology and Pacing, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Rong
authors.initials: R
authors.lastname: Bai
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.forename: Claude
authors.initials: C
authors.lastname: Elayi
authors.forename: Chi Keong
authors.initials: CK
authors.lastname: Ching
authors.forename: Conor
authors.initials: C
authors.lastname: Barrett
authors.forename: Karen
authors.initials: K
authors.lastname: Philipps
authors.forename: Pascal
authors.initials: P
authors.lastname: Lim
authors.forename: Dimpi
authors.initials: D
authors.lastname: Patel
authors.forename: Tom
authors.initials: T
authors.lastname: Callahan
authors.forename: David O
authors.initials: DO
authors.lastname: Martin
authors.forename: Mauricio
authors.initials: M
authors.lastname: Arruda
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schweikert
authors.forename: Walid I
authors.initials: WI
authors.lastname: Saliba
authors.forename: Bruce
authors.initials: B
authors.lastname: Wilkoff
authors.forename: Andrea
authors.initials: A
authors.lastname: Natale
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D009820:Ohio / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate