CRT device with an algorithm reduces 30-day readmissions

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Patients using cardiac resynchronization therapy (CRT) devices equipped with an algorithm were significantly less likely to be readmitted to hospitals within 30 days following discharge for heart failure and all other causes.  

Randall C. Starling, MD, MPH, of the Cleveland Clinic, and colleagues published their findings online in the Journal of the American College of Cardiology: Heart Failure on June 10.

“Other studies have shown the impact of CRT on readmissions over a 6-month period, but this study is the first to demonstrate a reduction in the 30-day readmission rate with CRT and to specifically utilize a novel algorithm to optimize resynchronization therapy,” they wrote.

They mentioned CRT is common for patients with heart failure symptoms, left ventricular systolic dysfunction and a wide QRS. Although studies have shown CRT is safe and effective, some patients do not respond to the therapy.

In this trial, the researchers analyzed the Adaptive CRT trial that randomized 478 patients undergoing CRT defibrillation on a 2:1 basis to receive CRT with Medtronic’s AdaptivCRT algorithm or CRT with echocardiographic optimization.

After a mean follow-up period of 20.2 months, 19.1 percent of patients in the algorithm group and 35.7 percent of patients in the echocardiographic group were readmitted for heart failure. Meanwhile, the 30-day readmission rate for all-cause hospitalizations was 14.8 percent and 24.8 percent, respectively.

The findings were significant, Starling et al noted, because of the increased importance of reducing readmissions and its effect on reimbursement. In 2012, the Centers for Medicare & Medicaid Services (CMS) established the Hospital Readmissions Reduction Program, which penalizes hospitals and reduces their inpatient reimbursement if they have too many 30-day readmissions.

They also mentioned that the CMS program includes readmissions for heart failure, acute MI, pneumonia, chronic obstructive pulmonary disease and total hip and knee arthroplasties. Starting on Oct. 1, 2014, the penalty increased from 2 percent to 3 percent of reimbursement.

A randomized trial is under way to determine if CRT with the algorithm can reduce all-cause mortality and interventions for heart failure decompensation.