Purpose: Cardiac resynchronization therapy with implantable cardioverter defibrillator (CRT-D) has been shown to improve symptoms in patients with chronic heart failure (CHF). However, reduction of all cause mortality is being debated. To evaluate whether CRT-D reduces all cause mortality compared with no-CRT-D in patients with CHF, a meta-analysis of randomized controlled trials was performed.
Data sources: Data sources are MEDLINE (1994-2008), EMBASE (1994-2008), the Cochrane Controlled Trials Register (Second Quarter, 2008), the National Institutes of Health Clinical Trials.gov database of clinical trials and the US Food and Drug Administration Website (1994-2008). Search terms included cardiac resynchronization therapy with implantable cardioverter defibrillator, biventricular implantable cardioverter defibrillator, cardiac resynchronization therapy, and CRT-D.
Review methods: Two reviewers independently assessed trial eligibility and quality. Eligible studies were randomized controlled trials of CRT-D for the treatment of CHF. Eligible studies reported all cause deaths as outcomes. Seven randomized trials were included in the meta-analysis, comparing CRT-D with no-CRT-D. The outcome was all cause mortality.
Results: A total of 747 events occurred in 4531 patients from seven randomized trials. Follow-up in the included trials ranged from 6 to 69 months. Most trials were high-quality. Pooled analysis demonstrated CRT-D significantly reduced all cause mortality (odds ratios (OR) 0.55, 95% confidence interval 0.40 to 0.76, P=0.0002). Subgroup analysis CRT-D vs CRT alone and CRT-D vs medical therapy alone, significantly reduced all cause mortality (OR 0.48, 95% confidence interval 0.31 to 0.75, P=0.001; OR 0.64, 95% confidence interval 0.46 to 0.90, P=0.009; respectively).
Conclusions: CRT-D significantly reduces all cause mortality in patients with advanced CHF.
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