Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient‐Level Meta‐Analysis
Background Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory New York Heart Association (NYHA) IV versus III functional class at the time of device implan...
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Wiley
2024-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031785 |
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| author | Nishkala Shivakumar Daniel J. Friedman Marat Fudim William T. Abraham John G. F. Cleland Anne B. Curtis Michael R. Gold Valentina Kutyifa Cecilia Linde James Young Anthony Tang Antonio Olivas‐Martinez Lurdes Y.T. Inoue Gillian D. Sanders Sana M. Al‐Khatib |
| author_facet | Nishkala Shivakumar Daniel J. Friedman Marat Fudim William T. Abraham John G. F. Cleland Anne B. Curtis Michael R. Gold Valentina Kutyifa Cecilia Linde James Young Anthony Tang Antonio Olivas‐Martinez Lurdes Y.T. Inoue Gillian D. Sanders Sana M. Al‐Khatib |
| author_sort | Nishkala Shivakumar |
| collection | DOAJ |
| description | Background Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory New York Heart Association (NYHA) IV versus III functional class at the time of device implantation. Methods and Results In this meta‐analysis, we pooled patient‐level data from the MIRACLE (Multicenter InSync Randomized Clinical Evaluation), MIRACLE‐ICD (Multicenter InSync Implantable Cardioversion Defibrillation Randomized Clinical Evaluation), and COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trials. Outcomes evaluated were time to the composite end point of the first heart failure hospitalization or all‐cause mortality, and time to all‐cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian hierarchical Weibull survival regression model. We assessed if this association differed between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from RAFT (Resynchronization‐Defibrillation for Ambulatory Heart Failure). Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to heart failure hospitalization or all‐cause mortality (adjusted hazard ratio [aHR], 0.79 [95% credible interval [CI], 0.64–0.99]; posterior probability or P=0.044), with a similar association with time to all‐cause mortality (aHR, 0.78 [95% CI, 0.59–1.03]; P=0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR, 0.72 [95% CI, 0.30–1.27]; P=0.23 for heart failure hospitalization/mortality; ratio of aHR, 0.70 [95% CI, 0.35–1.34]; P=0.27 for all‐cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes. Conclusions Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV. |
| format | Article |
| id | doaj-art-62e30ebda8534c40b1c0070fdf7feb5e |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-62e30ebda8534c40b1c0070fdf7feb5e2025-08-20T03:10:31ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131510.1161/JAHA.123.031785Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient‐Level Meta‐AnalysisNishkala Shivakumar0Daniel J. Friedman1Marat Fudim2William T. Abraham3John G. F. Cleland4Anne B. Curtis5Michael R. Gold6Valentina Kutyifa7Cecilia Linde8James Young9Anthony Tang10Antonio Olivas‐Martinez11Lurdes Y.T. Inoue12Gillian D. Sanders13Sana M. Al‐Khatib14Department of Medicine Duke University School of Medicine Durham NC USADivision of Cardiology, Department of Medicine Duke University School of Medicine Durham NC USADivision of Cardiology, Department of Medicine Duke University School of Medicine Durham NC USADivision of Cardiovascular Medicine The Ohio State University Columbus OH USANational Heart and Lung Institute, Royal Brompton & Harefield Hospitals Imperial College London United KingdomDepartment of Medicine University at Buffalo Buffalo NY USADepartment of Medicine Medical University of South Carolina Charleston SC USADivision of Cardiology, Department of Medicine University of Rochester Medical Center Rochester NY USAKarolinska Institutet and Department of Cardiology Karolinska University Stockholm SwedenCleveland Clinic Lerner College of Medicine of Case Western Reserve University Cleveland OH USADepartment of Medicine Western University Ontario CanadaDepartment of Biostatistics University of Washington Seattle WA USADepartment of Biostatistics University of Washington Seattle WA USADuke Clinical Research Institute Duke University School of Medicine Durham NC USADivision of Cardiology, Department of Medicine Duke University School of Medicine Durham NC USABackground Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory New York Heart Association (NYHA) IV versus III functional class at the time of device implantation. Methods and Results In this meta‐analysis, we pooled patient‐level data from the MIRACLE (Multicenter InSync Randomized Clinical Evaluation), MIRACLE‐ICD (Multicenter InSync Implantable Cardioversion Defibrillation Randomized Clinical Evaluation), and COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trials. Outcomes evaluated were time to the composite end point of the first heart failure hospitalization or all‐cause mortality, and time to all‐cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian hierarchical Weibull survival regression model. We assessed if this association differed between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from RAFT (Resynchronization‐Defibrillation for Ambulatory Heart Failure). Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to heart failure hospitalization or all‐cause mortality (adjusted hazard ratio [aHR], 0.79 [95% credible interval [CI], 0.64–0.99]; posterior probability or P=0.044), with a similar association with time to all‐cause mortality (aHR, 0.78 [95% CI, 0.59–1.03]; P=0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR, 0.72 [95% CI, 0.30–1.27]; P=0.23 for heart failure hospitalization/mortality; ratio of aHR, 0.70 [95% CI, 0.35–1.34]; P=0.27 for all‐cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes. Conclusions Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV.https://www.ahajournals.org/doi/10.1161/JAHA.123.031785cardiac resynchronization therapyheart failurehospitalizationproportional hazards model |
| spellingShingle | Nishkala Shivakumar Daniel J. Friedman Marat Fudim William T. Abraham John G. F. Cleland Anne B. Curtis Michael R. Gold Valentina Kutyifa Cecilia Linde James Young Anthony Tang Antonio Olivas‐Martinez Lurdes Y.T. Inoue Gillian D. Sanders Sana M. Al‐Khatib Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient‐Level Meta‐Analysis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac resynchronization therapy heart failure hospitalization proportional hazards model |
| title | Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient‐Level Meta‐Analysis |
| title_full | Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient‐Level Meta‐Analysis |
| title_fullStr | Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient‐Level Meta‐Analysis |
| title_full_unstemmed | Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient‐Level Meta‐Analysis |
| title_short | Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient‐Level Meta‐Analysis |
| title_sort | outcomes of cardiac resynchronization therapy by new york heart association class a patient level meta analysis |
| topic | cardiac resynchronization therapy heart failure hospitalization proportional hazards model |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031785 |
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