title: Changes in Drug Utilization and Outcome With Cardiac Resynchronization Therapy: A MADIT-CRT Substudy.
abstract: BACKGROUND
  This study sought to assess the association between medication utilization, outcome, and the efficacy of resynchronization therapy in the MADIT-CRT study.
  
  
  RESULTS
  Medication use by patients in the MADIT-CRT study was analyzed. Time-dependent Cox proportional hazard regression analyses were performed to assess differences in hospitalization for heart failure (HF) or death. The greater the efficacy of cardiac resynchronization therapy (CRT) as measured by reduction in left ventricular end-systolic volume (LVESV) and increase in left ventricular ejection fraction (LVEF) between baseline and 1 year of follow-up, the greater the likelihood that patients remained on an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) and avoided use of or reduced treatment with diuretics. Treatment with diuretics was associated with a significantly increased risk of HF hospitalization or death (hazard ratio [HR] 1.87, 95% confidence interval [CI] 1.45-2.41; P < .001). In contrast, treatment with an ACE-I/ARB was associated with a significantly decreased risk of HF hospitalization or death (HR 0.58, 95% CI 0.42-0.80; P = .001).
  
  
  CONCLUSIONS
  In HF patients in New York Heart Association functional classes I and II and with wide QRS complexes, efficacy of CRT as measured by improvement in LVESV and LVEF was associated with an increased likelihood of remaining on an ACE-I/ARB and discontinuing diuretic therapy. Discontinuation of diuretics was reflective of improved hemodynamic response to CRT.
authors: Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado.
authors: Justin
authors: J
authors: Penn
authors: Heart Research Follow-up Program, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Sheba Medical Center and Tel Aviv University, Tel Aviv, Israel.
authors: Ilan
authors: I
authors: Goldenberg
authors: Heart Research Follow-up Program, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors: Scott
authors: S
authors: McNitt
authors: Heart Research Follow-up Program, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors: Bronislava
authors: B
authors: Polonsky
authors: Heart Research Follow-up Program, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors: Martin H
authors: MH
authors: Ruwald
authors: Heart Research Follow-up Program, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors: Wojciech
authors: W
authors: Zareba
authors: Heart Research Follow-up Program, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
authors: Arthur J
authors: AJ
authors: Moss
authors: Heart Research Follow-up Program, Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York. Electronic address: Jeffrey_alexis@urmc.rochester.edu.
authors: Jeffrey D
authors: JD
authors: Alexis
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000706:statistics & numerical data; D017147:Defibrillators, Implantable; D004232:Diuretics / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume / Q000187:drug effects; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics
keywords: Heart failure; angiotensin receptor blocker; angiotensin-converting enzyme inhibitor; diuretic; resynchronization