A subanalysis within the RAFT (Resynchronization-defibrillation for ambulatory heart failure) trial has shown significantly reduced hospitalisations with implantable cardioverter defibrillators with cardiac resynchronisation therapy (ICD-CRT) devices compared with ICD alone devices in heart failure patients.
Anne Gillis from the Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Calgary, Canada and others published the results of RAFT’s subanalysis in Circulation.
Gillis et al report they analysed hospitalisation rates and length of hospital stay between patients treated with ICD-CRT compared with patients treated with ICD alone. At 18 months, they write, the number of patients hospitalised for any cause was similar in the ICD (n=351, 38.8%) and ICD-CRT groups (n=331, 30%). However, the number of hospitalisations due to heart failure was significantly lower in the ICD-CRT group (n=101, 11.3%) compared with the ICD alone group (n=141, 15.6%, p=0.003).
The authors also found that during follow-up the total number of hospitalisations for any cause and any cardiovascular cause was significantly lower in the ICD-CRT group vs. the ICD group. Nevertheless, the ICD-CRT group had a higher number of hospitalisations for device-related causes-primarily due to lead repositioning or lead replacement and replacement of the pulse generator due to battery depletion-compared with the ICD group (246 vs. 159, p<0.001). ICD-CRT hospitalised patients for any cause stayed shorter in the hospital in relation to the ICD treated patients (8.83±13.30 days vs. 9.59±14.40 days, p=0.005).
Gillis et al conclude that hospitalisations and length of hospital stay are significantly reduced in patients with New York Heart Association (NYHA) class II or III heart failure treated with ICD-CRT therapy compared with ICD alone despite increased admissions for device related indications. This reduction “would be anticipated to result in substantial health care savings but the magnitude of this benefit awaits completion of a detailed cost effectiveness analysis,” they note.
This study was supported by the Canadian Institutes for Health Research and Medtronic of Canada.
RAFT was a randomised, multicentre study (Canada, Europe and Australia) of over 1,700 patients with NYHA class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more or a paced QRS duration of 200 msec or more to receive either an ICD alone or an ICD plus CRT. The results of the study showed that patients treated with combined ICD/CRT experienced improved survival and were significantly less likely to be hospitalised for heart failure.