CRT-D devices with AdaptivCRT associated with reduction of costs of AF


New data from the Medtronic Adaptive CRT trial show a 61% (p=0.01) lower risk of atrial fibrillation (AF)-related problems in patients who receive a cardiac resynchronisation therapy-defibrillator (CRT-D) with the Medtronic-exclusive AdaptivCRT algorithm compared to conventional biventricular pacing therapy. Presented at Cardiostim 2014, the data also indicate a 55% relative reduction in healthcare utilisations (including hospitalisations, emergency department or clinic visits) when patients have devices with AdaptivCRT.

Previous data from this trial showed patients with heart failure who received the AdaptivCRT technology were at a 46% lower risk of spending 48 consecutive hours or more in AF compared to conventional CRT patients.

According to the analysis of 476 patients, potential use of healthcare resources because of AF are reduced with the AdaptivCRT technology; specific data was presented for the healthcare systems in the United States and Germany, which showed AF-related provider cost savings of US$630 per patient and €130 over 24 months, respectively. Nearly all of these cost savings (92% in the USA, 93% in Germany) were from a reduction in hospitalisations.

“The study results are clear in showing that CRT devices with adaptive algorithms reduce the risk of atrial fibrillation adverse events and related costs,” says Bernd Lemke, head of the Department of Cardiology at Lüdenscheid Hospital, Germany. “On an individual level, the algorithm’s personalised therapy helps keep more patients out of the hospital. On a system-level, this results in savings and less use of healthcare resources.”

Recent data presented at Heart Rhythm 2014 from the Adaptive CRT trial also showed that the AdaptivCRT feature reduced 30-day readmissions for heart failure by nearly half, and 30-day readmissions for all-cause hospitalisations by more than 40%, which are both noteworthy since readmissions within 30 days of discharge may result in reduced or no payment under many payment settings.

Because of the favourable evidence showing reduction in AF incidence and all-cause hospitalisations among patients with the AdaptivCRT technology, Medtronic plans to conduct a global study of 3,000 patients to evaluate the superiority of CRT with AdaptivCRT therapy in reducing heart failure events and mortality, compared to conventional bi-ventricular pacing.

The AdaptivCRT feature, found on market-released Medtronic Viva CRT-D and Viva CRT-P devices, works by preserving normal heart rhythms and automatically adjusting to the patient’s needs every minute, creating a customised therapy for each patient. The research presented at Cardiostim builds on previous findings from the Adaptive CRT trial that showed the benefits of the AdaptivCRT algorithm, including:

  • AdaptivCRT increases CRT response rate by 12%;
  • Patients with AdaptivCRT have demonstrated a 21% reduction in heart failure hospitalisation and a reduced risk of death;
  • Patients with the AdaptivCRT technology have a 46% reduced risk of AF.

“As today’s healthcare environment evolves and more focus is placed on curbing readmission rates, hospital administrators and payers must increasingly focus on both the health benefits and quality of life of individual patients and the long-term cost savings of effective treatments,” says Sheri Dodd, vice president of Clinical Research, Healthcare Economics and Policy for the Cardiac Rhythm Disease Management business at Medtronic. “Hospital administrators must increasingly look to new solutions for tackling heart failure and associated costs, and this is made easier with this data showing the benefit of implanting devices that have the adaptive algorithm.”