Heart FailureTemporal Influence of Heart Failure Hospitalizations Prior to Implantable Cardioverter Defibrillator or Cardiac Resynchronization Therapy With Defibrillator on Subsequent Outcome in Mild Heart Failure Patients (from MADIT-CRT)
Section snippets
Methods
The design, protocol, and results of MADIT-CRT have previously been published.2, 10 Briefly, MADIT-CRT was a randomized, multicenter trial designed to determine the possible benefit of implanting a CRT-D device compared with an implantable cardioverter-defibrillator (ICD) in patients with mild HF, prolonged QRS duration and depressed left ventricular ejection fractions. From December 22, 2004, through June 24, 2009, the trial enrolled 1,820 patients from 110 different centers in the United
Results
Of 1,820 patients in the original MADIT-CRT trial, 1,250 (68.7%) had LBBB QRS morphology, with 746 patients treated with CRT-D and 504 with ICDs. The baseline characteristics of the 1,250 patients with LBBB subcategorized into no previous HF hospitalization (n = 774), previous HF hospitalization ≤12 months (n = 253), and previous HF hospitalization ≥12 months (n = 253) before CRT-D implantation are listed in Table 1. In general, the group with previous HF hospitalization within 12 months before
Discussion
In this substudy of MADIT-CRT involving patients with mild HF with LBBB QRS morphology, we found an increased risk for HF or death associated with a recent HF hospitalization ≤12 months before device implantation compared with patients with no previous HF hospitalization and those with previous HF hospitalization >12 months. All 3 groups derived similar and significant CRT-D benefit compared with ICD-treated patients, irrespective of previous HF hospitalizations and time from previous HF
Disclosures
Dr. Zareba and Dr. Moss have received grant support from Boston Scientific. Dr. Ruwald was a Mirowski-Moss Awardee and has received unrestricted travel grants from the Denmark-America Foundation, Falck Denmark, The Lundbeck-Foundation, Bønnelykkefonden, Carl and Ellen Hertz Grant, and Torben and Alice Frimodts Foundation.
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Cited by (4)
What happens to non-responders in cardiac resynchronization therapy?
2017, Revista Portuguesa de CardiologiaCitation Excerpt :In addition, significant mitral regurgitation (grade >2+) post-CRT was found to be independently associated with all-cause mortality, as also described in the Cardiac Resynchronization in Heart Failure Trial38 and by van Bommel et al.39 Another clinical parameter with impact on mortality was hospitalization due to HF during the first year of follow-up. The importance of HF admissions after CRT was also shown by Bertini et al.,20 and data from the MADIT-CRT trial revealed an association between future events and HF admission during the 12 months before CRT implantation.40 Finally, these data indicate that lack of clinical improvement in patients without LVRR after CRT was a strong marker of worse prognosis.
Digoxin therapy and associated clinical outcomes in the MADIT-CRT trial
2015, Heart RhythmCitation Excerpt :Additional subgroup analyses were performed separately for HF events and death. Based on our recent article,21 subanalyses were conducted for patients who had HF hospitalization <1 year before enrollment and for patients who had HF hospitalization ≥1 year before enrollment for the end points HF/death, HF alone, and death alone. An independent mortality and HF committee adjudicated all primary end points according to prespecified criteria described in the original protocol.
A Systematic Assessment of Absolute Treatment Effect
2015, American Journal of CardiologyMachine Learning Algorithm Predicts Cardiac Resynchronization Therapy Outcomes: Lessons from the COMPANION Trial
2018, Circulation: Arrhythmia and Electrophysiology
The MADIT-CRT study was supported by a research grant from Boston Scientific, Natick, Massachusetts, to the University of Rochester, with funds distributed to the coordination and data center, enrolling centers, core laboratories, committees, and boards under subcontracts from the University of Rochester. ClinicalTrials.gov identifier NCT00180271.
See page 1427 for disclosure information.