Long-term mortality with cardiac resynchronization therapy in the Cardiac Resynchronization-Heart Failure (CARE-HF) trial

被引:115
作者
Cleland, John G. F. [1 ]
Freemantle, Nick [7 ]
Erdmann, Erland [2 ]
Gras, Daniel [3 ]
Kappenberger, Lukas [4 ]
Tavazzi, Luigi [5 ]
Daubert, Jean-Claude [6 ]
机构
[1] Univ Hull, Castle Hill Hosp, Dept Cardiol, Kingston Upon Hull, Yorks, England
[2] Univ Cologne, Innere Med Klin 3, D-50924 Cologne, Germany
[3] Nouvelles Clin Nantaises, Nantes, France
[4] Univ Lausanne, CH-1015 Lausanne, Switzerland
[5] Maria Cecilia Hosp, GVM Care & Res, Cotignola, Italy
[6] Hop Pontchaillou, Dept Cardiol, Rennes, France
[7] Univ Birmingham Edgbaston, Birmingham, W Midlands, England
关键词
Heart failure; Randomized trial; Cardiac resynchronization therapy; COST-EFFECTIVENESS; DEVICE THERAPY; DEFIBRILLATOR; MORBIDITY;
D O I
10.1093/eurjhf/hfs055
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The Cardiac Resynchronization-Heart Failure (CARE-HF) study helped establish an important role for cardiac resynchronization therapy (CRT) in the management of selected patients with heart failure. We now report the long-term outcome during and subsequent to the randomized trial. Enrolment was completed in March 2003. After reporting the main study results in 2005, investigators were asked to inform patients of the results and implant a CRT device if still appropriate. Subsequently, investigators were asked to consent patients for long-term follow-up until 30 September 2009. Of 813 patients originally enrolled, 343 (42) died prior to re-consent, 111 patients (14) were not or could not be contacted, 50 (6) were alive but declined to participate, and 309 (38) consented to long-term follow-up. Of patients originally assigned to the control group, 95 of survivors had received CRT by the time of re-consent. From the time of randomization, 222 patients originally assigned to pharmacological therapy and 192 originally assigned to CRT were known to have died. The hazard ratio for mortality in patients originally assigned to CRT compared with those originally assigned to the control group was 0.77 (95 confidence interval 0.630.93; P 0.007). No subgroup interactions were observed. The effect of CRT on mortality observed during the randomized CARE-HF trial persisted during long-term follow-up. A high rate of CRT device implantation in the control group after completion of the randomized phase of the study may have prevented further divergence of the survival curves.
引用
收藏
页码:628 / 634
页数:7
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