Cardiac Resynchronization and Death from Progressive Heart Failure: A Meta-analysis of Randomized Controlled Trials

David J. Bradley, Elizabeth A. Bradley, Kenneth L. Baughman, Ronald D Berger, Hugh Calkins, Steven N. Goodman, David A Kass, Neil R. Powe

Research output: Contribution to journalArticle

Abstract

Context: Progressive heart failure is the most common mechanism of death among patients with advanced heart failure. Cardiac resynchronization, a pacemaker-based therapy for heart failure, enhances cardiac performance and quality of life, but its effect on mortality is uncertain. Objective: To determine whether cardiac resynchronization reduces mortality from progressive heart failure. Data Sources: MEDLINE (1966-2002), EMBASE (1980-2002), the Cochrane Controlled Trials Register (Second Quarter, 2002), The National Institutes of Health ClinicalTrials.gov database, the US Food and Drug Administration Web site, and reports presented at scientific meetings (1994-2002). Search terms included pacemaker, pacing, heart failure, dual-site, multisite, biventricular, resynchronization, and left ventricular preexcitation. Study Selection: Eligible studies were randomized controlled trials of cardiac resynchronization for the treatment of chronic symptomatic left ventricular dysfunction. Eligible studies reported death, hospitalization for heart failure, or ventricular arrhythmia as outcomes. Of the 6883 potentially relevant reports initially identified, 11 reports of 4 randomized trials with 1634 total patients were included in the meta-analysis. Data Extraction: Trial reports were reviewed independently by 2 investigators in an unblinded standardized manner. Data Synthesis: Follow-up in the included trials ranged from 3 to 6 months. Pooled data from the 4 selected studies showed that cardiac resynchronization reduced death from progressive heart failure by 51% relative to controls (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.25-0.93). Progressive heart failure mortality was 1.7% for cardiac resynchronization patients and 3.5% for controls. Cardiac resynchronization also reduced heart failure hospitalization by 29% (OR, 0.71; 95% CI, 0.53-0.96) and showed a trend toward reducing all-cause mortality (OR, 0.77; 95% CI, 0.51-1.18). Cardiac resynchronization was not associated with a statistically significant effect on non-heart failure mortality (OR, 1.15; 95% CI, 0.65-2.02). Among patients with implantable cardioverter defibrillators, cardiac resynchronization had no clear impact on ventricular tachycardia or ventricular fibrillation (OR, 0.92; 95% CI, 0.67-1.27). Conclusions: Cardiac resynchronization reduces mortality from progressive heart failure in patients with symptomatic left ventricular dysfunction. This finding suggests that cardiac resynchronization may have a substantial impact on the most common mechanism of death among patients with advanced heart failure. Cardiac resynchronization also reduces heart failure hospitalization and shows a trend toward reducing all-cause mortality.

Original languageEnglish (US)
Pages (from-to)730-740
Number of pages11
JournalJournal of the American Medical Association
Volume289
Issue number6
DOIs
StatePublished - Feb 12 2003

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Cardiac Resynchronization Therapy
Meta-Analysis
Randomized Controlled Trials
Heart Failure
Mortality
Odds Ratio
Confidence Intervals
Hospitalization
Left Ventricular Dysfunction
Implantable Defibrillators
Information Storage and Retrieval
National Institutes of Health (U.S.)
Ventricular Fibrillation
United States Food and Drug Administration
Ventricular Tachycardia
MEDLINE
Cardiac Arrhythmias

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cardiac Resynchronization and Death from Progressive Heart Failure : A Meta-analysis of Randomized Controlled Trials. / Bradley, David J.; Bradley, Elizabeth A.; Baughman, Kenneth L.; Berger, Ronald D; Calkins, Hugh; Goodman, Steven N.; Kass, David A; Powe, Neil R.

In: Journal of the American Medical Association, Vol. 289, No. 6, 12.02.2003, p. 730-740.

Research output: Contribution to journalArticle

Bradley, David J. ; Bradley, Elizabeth A. ; Baughman, Kenneth L. ; Berger, Ronald D ; Calkins, Hugh ; Goodman, Steven N. ; Kass, David A ; Powe, Neil R. / Cardiac Resynchronization and Death from Progressive Heart Failure : A Meta-analysis of Randomized Controlled Trials. In: Journal of the American Medical Association. 2003 ; Vol. 289, No. 6. pp. 730-740.
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abstract = "Context: Progressive heart failure is the most common mechanism of death among patients with advanced heart failure. Cardiac resynchronization, a pacemaker-based therapy for heart failure, enhances cardiac performance and quality of life, but its effect on mortality is uncertain. Objective: To determine whether cardiac resynchronization reduces mortality from progressive heart failure. Data Sources: MEDLINE (1966-2002), EMBASE (1980-2002), the Cochrane Controlled Trials Register (Second Quarter, 2002), The National Institutes of Health ClinicalTrials.gov database, the US Food and Drug Administration Web site, and reports presented at scientific meetings (1994-2002). Search terms included pacemaker, pacing, heart failure, dual-site, multisite, biventricular, resynchronization, and left ventricular preexcitation. Study Selection: Eligible studies were randomized controlled trials of cardiac resynchronization for the treatment of chronic symptomatic left ventricular dysfunction. Eligible studies reported death, hospitalization for heart failure, or ventricular arrhythmia as outcomes. Of the 6883 potentially relevant reports initially identified, 11 reports of 4 randomized trials with 1634 total patients were included in the meta-analysis. Data Extraction: Trial reports were reviewed independently by 2 investigators in an unblinded standardized manner. Data Synthesis: Follow-up in the included trials ranged from 3 to 6 months. Pooled data from the 4 selected studies showed that cardiac resynchronization reduced death from progressive heart failure by 51{\%} relative to controls (odds ratio [OR], 0.49; 95{\%} confidence interval [CI], 0.25-0.93). Progressive heart failure mortality was 1.7{\%} for cardiac resynchronization patients and 3.5{\%} for controls. Cardiac resynchronization also reduced heart failure hospitalization by 29{\%} (OR, 0.71; 95{\%} CI, 0.53-0.96) and showed a trend toward reducing all-cause mortality (OR, 0.77; 95{\%} CI, 0.51-1.18). Cardiac resynchronization was not associated with a statistically significant effect on non-heart failure mortality (OR, 1.15; 95{\%} CI, 0.65-2.02). Among patients with implantable cardioverter defibrillators, cardiac resynchronization had no clear impact on ventricular tachycardia or ventricular fibrillation (OR, 0.92; 95{\%} CI, 0.67-1.27). Conclusions: Cardiac resynchronization reduces mortality from progressive heart failure in patients with symptomatic left ventricular dysfunction. This finding suggests that cardiac resynchronization may have a substantial impact on the most common mechanism of death among patients with advanced heart failure. Cardiac resynchronization also reduces heart failure hospitalization and shows a trend toward reducing all-cause mortality.",
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AU - Berger, Ronald D

AU - Calkins, Hugh

AU - Goodman, Steven N.

AU - Kass, David A

AU - Powe, Neil R.

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N2 - Context: Progressive heart failure is the most common mechanism of death among patients with advanced heart failure. Cardiac resynchronization, a pacemaker-based therapy for heart failure, enhances cardiac performance and quality of life, but its effect on mortality is uncertain. Objective: To determine whether cardiac resynchronization reduces mortality from progressive heart failure. Data Sources: MEDLINE (1966-2002), EMBASE (1980-2002), the Cochrane Controlled Trials Register (Second Quarter, 2002), The National Institutes of Health ClinicalTrials.gov database, the US Food and Drug Administration Web site, and reports presented at scientific meetings (1994-2002). Search terms included pacemaker, pacing, heart failure, dual-site, multisite, biventricular, resynchronization, and left ventricular preexcitation. Study Selection: Eligible studies were randomized controlled trials of cardiac resynchronization for the treatment of chronic symptomatic left ventricular dysfunction. Eligible studies reported death, hospitalization for heart failure, or ventricular arrhythmia as outcomes. Of the 6883 potentially relevant reports initially identified, 11 reports of 4 randomized trials with 1634 total patients were included in the meta-analysis. Data Extraction: Trial reports were reviewed independently by 2 investigators in an unblinded standardized manner. Data Synthesis: Follow-up in the included trials ranged from 3 to 6 months. Pooled data from the 4 selected studies showed that cardiac resynchronization reduced death from progressive heart failure by 51% relative to controls (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.25-0.93). Progressive heart failure mortality was 1.7% for cardiac resynchronization patients and 3.5% for controls. Cardiac resynchronization also reduced heart failure hospitalization by 29% (OR, 0.71; 95% CI, 0.53-0.96) and showed a trend toward reducing all-cause mortality (OR, 0.77; 95% CI, 0.51-1.18). Cardiac resynchronization was not associated with a statistically significant effect on non-heart failure mortality (OR, 1.15; 95% CI, 0.65-2.02). Among patients with implantable cardioverter defibrillators, cardiac resynchronization had no clear impact on ventricular tachycardia or ventricular fibrillation (OR, 0.92; 95% CI, 0.67-1.27). Conclusions: Cardiac resynchronization reduces mortality from progressive heart failure in patients with symptomatic left ventricular dysfunction. This finding suggests that cardiac resynchronization may have a substantial impact on the most common mechanism of death among patients with advanced heart failure. Cardiac resynchronization also reduces heart failure hospitalization and shows a trend toward reducing all-cause mortality.

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