New data from Medtronic show that its cardiac resynchronisation therapy (CRT) devices for the treatment of heart failure can cause a significant reduction in all-cause 30-day readmissions after heart failure hospitalisations.
Heart failure patients who benefited early from CRT lived longer and consumed fewer hospital resources than patients who did not experience early benefit from the therapy. These new data were featured in separate presentations at the American Heart Association’s Scientific Sessions 2014 in Chicago.
“These new economic data reinforce the important benefits of CRT and demonstrate its value, not only for patient health, but also the fiscal health of the hospitals and health systems that treat them,” says Linda Gillam, chair, cardiovascular medicine, Atlantic Health System, USA.
In the meta-analysis titled, “Reduced 30-day hospital readmissions in systolic heart failure patients with cardiac resynchronisation therapy: Evidence from five randomized controlled trials,” researchers analysed pooled data from five Medtronic-sponsored randomised controlled trials (CARE-HF, MIRACLE, MIRACLE-ICD, RAFT and REVERSE) involving 3,872 patients, to determine whether CRT reduces the rate of all-cause readmission within 30 days of a heart failure hospitalisation. Among the 678 patients with an index heart failure hospitalisation, there was a 26% relative reduction of hospital readmissions in patients treated with CRT. For patients with more advanced heart failure, class III/IV, the benefit was higher, at 31%, than class II patients at 10%.
In a separate presentation titled, “Clinical and economic value of maximising response to cardiac resynchronisation therapy (CRT): Evidence from five randomised controlled trials,” researchers found that patients who improved or remained unchanged six months after CRT were projected to live longer and consumed fewer hospital resources than patients who worsened.
Results were measured using the Packer clinical composite score (CCS), which analyses a patient’s condition as improved, unchanged or worsened using variables including death, heart failure hospitalisation, a patient global assessment questionnaire, and change in symptoms as measured by New York Heart Association (NYHA) heart failure class.
The pooled analysis of five Medtronic-sponsored trials (MIRACLE, MIRACLE-ICD, InSync III Marquis, PROSPECT and Adaptive CRT) identified 1,603 total patients, 1,089 of which improved (68%), 235 remained unchanged (15%) and 279 worsened (17%). Patients who improved or remained unchanged at six months of receiving CRT were projected (using Markov modelling) to live approximately eight years compared to less than two years in the worsened group.
Additionally, heart failure hospitalisation rates in the first year after the six-month clinical composite score assessment were 0.13 for those who improved, 0.27 for those who were unchanged and more than three times higher (0.90) for those who worsened (p<0.0001).