Adaptive CRT: Pacing algorithm lowered 30-day readmission rate

SAN FRANCISCO — A novel pacing algorithm was associated with lower 30-day readmission rates in patients with HF, according to new data from the Adaptive CRT study.

Researchers investigated the effect of the algorithm, AdaptivCRT (Medtronic), on 30-day readmissions after HF and all-cause index hospitalizations. They presented their findings at the Heart Rhythm Society Annual Scientific Sessions.

Randall C. Starling, MD, MPH, vice chairman of cardiovascular medicine and section head of the Heart Failure Center Heart and Vascular Institute at Cleveland Clinic, and colleagues randomly assigned 478 patients with HF to a cardiac resynchronization therapy defibrillator with AdaptivCRT (n=318) or with echo-optimization (n=160). Patients who had at least one index hospitalization during the follow-up period (AdaptivCRT group, 204; control group, 108) were included in the analysis. Mean follow-up was 20.2 months.

For HF-related index hospitalizations, there was a relative reduction of 46.5% in 30-day readmissions for the AdaptivCRT group compared with the control group (19.1% vs. 35.7%; P=.05). For all-cause index hospitalizations, there was a relative reduction of 40.3% in 30-day readmissions for the AdaptivCRT group compared with the control group (14.8% vs. 24.8%; P=.02), according to the results.

In a subgroup with normal atrioventricular conduction, for HF index hospitalizations, there was a relative reduction of 62.9% in 30-day readmissions for the AdaptivCRT group compared with the control group (14.3% vs. 38.5%; P=.06), and for all-cause index hospitalizations, there was a relative reduction of 61.1% in 30-day readmissions for the AdaptivCRT group compared with the control group (10.3% vs. 26.5%; P>.01), according to the researchers.

The reduction in readmissions between patients with normal atrioventricular and prolonged atrioventricular conduction was not statistically different.

Starling and colleagues performed a generalized estimating equations (GEE) analysis to take within-patient correlation into account, since some patients had multiple hospitalizations. In the GEE analysis, the reduction in 30-day readmissions for the AdaptivCRT group was significant for both HF index hospitalizations (P=.02) and all-cause index hospitalizations (P=.03).

“In addition to the previously demonstrated clinical benefit, a novel pacing algorithm has the potential to improve health care economics by lowering 30-day readmission rates,” Starling and colleagues wrote in an abstract. – by Erik Swain

For more information:

Starling RC. Abstract PO01-196. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 7-10, 2014; San Francisco.

Disclosure: Starling reports receiving modest consulting fees/honoraria from Medtronic, Novartis and Thoratec.