title: Clinical effectiveness of cardiac resynchronization therapy versus medical therapy alone among patients with heart failure: analysis of the ICD Registry and ADHERE.
abstract: BACKGROUND
  Cardiac resynchronization therapy with defibrillator (CRT-D) reduces morbidity and mortality among selected patients with heart failure in clinical trials. The effectiveness of this therapy in clinical practice has not been well studied.
  
  
  RESULTS
  We compared a cohort of 4471 patients from the National Cardiovascular Data Registry's Implantable Cardioverter-Defibrillator (ICD) Registry hospitalized primarily for heart failure and who received CRT-D between April 1, 2006, and December 31, 2009, to a historical control cohort of 4888 patients with heart failure without CRT-D from the Acute Decompensated Heart Failure National Registry (ADHERE) hospitalized between January 1, 2002, and March 31, 2006. Both registries were linked with Medicare claims to evaluate longitudinal outcomes. We included patients from the ICD Registry with left ventricular ejection fraction ≤35% and QRS duration ≥120 ms who were admitted for heart failure. We used Cox proportional hazards models to compare outcomes with and without CRT-D after adjustment for important covariates. After multivariable adjustment, CRT-D was associated with lower 3-year risks of death (hazard ratio, 0.52; 95% confidence interval, 0.48-0.56; P<0.001), all-cause readmission (hazard ratio, 0.69; 95% confidence interval, 0.65-0.73; P<0.001), and cardiovascular readmission (hazard ratio, 0.60; 95% confidence interval, 0.56-0.64; P<0.001). The association of CRT-D with mortality did not vary significantly among subgroups defined by age, sex, race, QRS duration, and optimal medical therapy.
  
  
  CONCLUSIONS
  CRT-D was associated with lower risks of mortality, all-cause readmission, and cardiovascular readmission than medical therapy alone among patients with heart failure in community practice.
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Prateeti
authors.initials: P
authors.lastname: Khazanie
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Laura G
authors.initials: LG
authors.lastname: Qualls
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Piccini
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: From the Duke Clinical Research Institute (P.K., B.G.H., L.G.Q., S.M.A.-K., J.P.P., A.F.H., L.H.C.) and Department of Medicine (P.K., S.M.A.-K., J.P.P., A.F.H., L.H.C.), Duke University School of Medicine, Durham, NC; Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles (G.C.F.); Department of Medicine, University of Colorado, Aurora (F.A.M., P.N.P.); Department of Medicine, Denver Health Medical Center, CO (P.N.P.); Department of Medicine, Mayo Clinic, Rochester, MN (S.C.H.); Department of Medicine, VA Palo Alto Healthcare System, CA (P.A.H., J.P.C.); Department of Medicine, Yale University School of Medicine, New Haven, CT (J.P.C.). lesley.curtis@duke.edu.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
mesh_terms: D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015999:Multivariate Analysis; D012042:Registries; D016896:Treatment Outcome
keywords: cardiac resynchronization therapy; comparative effectiveness research; defibrillators, implantable; heart failure