title: Clinical characteristics, mortality, cardiac hospitalization, and ventricular arrhythmias in patients undergoing CRT-D implantation: results of the ACTION-HF study.
abstract: BACKGROUND
  The characteristics and outcomes of patients who undergo cardiac resynchronization therapy (CRT) device implantation in current clinical practice may differ from those of reference trial populations. Study objectives were to assess 2-year outcomes in a population implanted with a CRT plus defibrillator device in accordance with the standard of care and to evaluate any independent association between clinical variables and outcome.
  
  
  RESULTS
  A total of 406 patients enrolled at 35 centers in Italy were followed up prospectively for 2 years. All patient management decisions were left to the treating physician's discretion, in accordance with clinical practice. ACTION-HF patients had a better baseline clinical status than patients enrolled in the COMPANION study: shorter HF history (1 vs 3.5 years, P < 0.01), less advanced NYHA functional class (III-IV: 73% vs 100%, P < 0.01), higher LVEF (26% vs 21%, P < 0.01), higher SBP (122 vs 112 mmHg, P < 0.01), and less diabetes (27% vs 41%, P < 0.01). This status was reflected in lower mortality (11.5% vs 26%) and a lower incidence of appropriate ICD shocks (12.1% vs 19.3%). AF history was an independent predictor of the combination of all-cause mortality and cardiac-cause hospitalization (HR: 3.31; P < 0.001). Recurrent or new atrial arrhythmias were independently associated with the development of ventricular arrhythmias (HR: 3.4; P < 0.001).
  
  
  CONCLUSIONS
  This population appears clinically less compromised and had a lower incidence of adverse clinical outcomes than those of reference trials. However, we recorded a substantial burden of atrial arrhythmias, which was independently associated with a higher incidence of ventricular arrhythmias.
authors.affiliation: S. Anna Hospital, San Fermo Della Battaglia, Como, Italy. gluca.botto@gmail.com
authors.forename: Giovanni Luca
authors.initials: GL
authors.lastname: Botto
authors.forename: Cosimo Damiano
authors.initials: CD
authors.lastname: Dicandia
authors.forename: Massimo
authors.initials: M
authors.lastname: Mantica
authors.forename: Concetto
authors.initials: C
authors.lastname: La Rosa
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: Giulio
authors.initials: G
authors.lastname: Molon
authors.forename: Roberto
authors.initials: R
authors.lastname: Verlato
authors.forename: Giovanni Quinto
authors.initials: GQ
authors.lastname: Villani
authors.forename: Alberto
authors.initials: A
authors.lastname: Scaccia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raciti
authors.forename: Eraldo
authors.initials: E
authors.lastname: Occhetta
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000401:mortality* / Q000706:statistics & numerical data; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000517:prevention & control*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000401:mortality* / Q000517:prevention & control*