ACC 2014 – CRT-D safer than ICD for HF patients with atrial fibrillation

March 29, 2014 – The DCRI’s Prateeti Khazani, MD, MPH, examined patient data from the National Cardiovascular Data Registry’s ICD Registry.

Patients with heart failure and atrial fibrillation who receive cardiac resynchronization therapy defibrillators (CRT-D) have lower rates of death and rehospitalization than patients who receive an implantable cardioverter defibrillator (ICD), according to a study presented in a poster session Saturday at the Scientific Sessions of the American College of Cardiology in Washington, DC.

The study was conducted by DCRI Fellow Prateeti Khazanie, MD, MPH (pictured); Melissa Greiner, MS; Sana Al-Khatib, MD, MHS; Jonathan Piccini, MD, MHS; Lesley Curtis, PhD; Adrian Hernandez, MD, MHS; and colleagues from Stanford University and the University of Colorado.

prateeti-khazanie-newsAtrial fibrillation is common in patients with heart failure, but the effectiveness of CRT-D compared to ICD is unclear. Current guidelines for cardiac devices designate CRT-D as class IIa devices for patients with atrial fibrillation, indicating significant but not overwhelming evidence in favor of its use. To better determine the effectiveness of CRT-D relative to ICD in this patient population, Khazanie and her colleagues examined patient data from the National Cardiovascular Data Registry’s ICD Registry.

“This is a question that hasn’t been looked at very closely,” Khazanie said.

The researchers obtained data on 8,951 patients treated at 1,160 hospitals across the United States. Of these patients, 6,470 (72 percent) received CRT-D and 2,481 (28 percent) received ICD. At three years, the mortality rate for CRT-D patients was 32.2 percent compared to 33 percent for ICD patients. Rates of all-cause hospitalization within three years were 75.9 percent for CRT-D versus 75.6 percent for ICD, and rates of hospitalization for heart failure within three years were 33.4 percent for CRT-D versus 36.2 for ICD.

After adjusting for the probability of CRT-D implantation, the researchers concluded that the risk of death, all-cause and heart failure rehospitalization were lower among patients receiving CRT-D compared to ICD, but there were no significant differences in 90-day complications.

“Overall, we found that CRT-D did appear to have a benefit in terms of mortality and rehospitalization,” Khazanie said.