ICD-CRT may lead to fewer hospitalizations than ICD alone

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Patients with heart failure who receive therapy consisting of an implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) have fewer hospitalizations than heart failure patients with only an ICD. The findings, published online March 7 in Circulation, were based on data from the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT).

The authors, led by Anne M. Gillis, MD, of the University of Calgary in Alberta, Canada, wanted to determine the impact of both therapy options on hospitalizations among the RAFT cohort.

The RAFT trial sought to evaluate whether adding CRT to ICD therapy would improve survival in patients with New York Heart Association Class II heart failure on optimal medical therapy, a left ventricular ejection fraction of 30 percent or less, an intrinsic QRS duration of 120 milliseconds or more or a paced QRS duration of 200 milliseconds, and an indication for an ICD to prevent sudden cardiac death. RAFT investigators randomized 1,798 patients to receive either ICD-CRT therapy or ICD therapy alone.

Gillis and colleagues compared hospitalization rates and lengths of hospital stay between the ICD only and ICD-CRT groups. At the 18-month follow-up point, the number of hospitalizations for any reason was similar in both groups (351 in the ICD-only group vs. 331 in the ICD-CRT group). There were significantly fewer patients in the ICD-CRT group hospitalized for heart failure (101 vs. 141), but significantly more in that same group were hospitalized for causes related to the device (246 vs. 159).

Over the entire study period, the ICD-CRT group had fewer hospitalizations (1,448 vs 1,553) and the number of cardiovascular hospitalizations was also lower in that group (667 vs. 790). Heart failure hospitalizations were also significantly lower among ICD-CRT patients, but device-related events were higher in that group (246 vs. 159).

However, the length of stay for any cause was significantly lower in the ICD-CRT group vs. the ICD-only group (8.83 days vs. 9.59 days). 

The investigators noted that their follow-up time was shorter than in the original RAFT trial. Nonetheless, they argued that despite the finding that device-related hospitalizations were higher in the ICD-CRT group, CRT indications have expanded and along with an increase in volume and experience with CRT, “complications related to the implant procedure are predicted to decline.”