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REVERSE: CRT may increase survival, reduce hospitalization risk for mild HF
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Cardiac resynchronization therapy may yield clinically significant long-term benefits in patients with mild HF, according to a new analysis of data from the REVERSE study.
REVERSE was a prospective, double blind study of 610 patients with NYHA Class I/II HF, QRS duration of at least 120 ms and left ventricular ejection fraction of up to 40%. All participants were implanted with a cardiac resynchronization therapy (CRT) device and randomly assigned at a 2:1 ratio to either active CRT (CRT-ON) or control (CRT-OFF). Participants were followed for up to 5 years, and the researchers used common parametric survival models to extrapolate the mortality data from REVERSE beyond the follow-up period.
CRT-ON and CRT-OFF were compared in terms of survival-years and HF hospitalizations. Researchers also evaluated the effects of device type (CRT alone [CRT-P] or CRT in combination with an implantable cardioverter defibrillator [CRT-D]) on outcomes.
CRT-ON was associated with a predicted 22.8% increase in survival over CRT-OFF at 10 years (CRT-ON, 52.5% vs. CRT-OFF, 29.7%; HR = 0.45; P = .21). This equated with an anticipated survival of 9.76 years for CRT-ON vs. 7.5 years for CRT-OFF, and a number needed to treat of 4.5 to avoid one death. Patients who received CRT were significantly more likely to regress to NYHA Class I (RRR = 1.39; 95% CI, 1.05-1.86) and less likely to be in Class III than patients who did not (RRR = 0.62; 95% CI, 0.38-1.03).
A significant survival benefit was seen with CRT-Ds compared with CRT-Ps on multivariate analysis (HR = 0.47; 95% CI, 0.25-0.88), which researchers predicted would confer an additional 2.77 life-years. Predicted disease progression did not differ significantly according to device type.
The effect of CRT on risk for HF hospitalization varied according to NYHA class: The predicted risk was significantly lower in patients with NYHA Class I HF compared with Class II (IRR = 0.69; 95% CI, 0.57-0.85 for Class I vs. Class II), and was significantly lower with NYHA Class II HF than Class III (IRR = 2.98; 95% CI, 2.29-3.87 for Class III vs. Class II).
“Our analyses demonstrated that implantation of a CRT device in a patient with NYHA Class II functional status, a reduced EF and QRS prolongation is expected to prolong survival on average 2.26 years,” The researchers wrote. “A patient with CRT-D is expected to survive 2.77 additional years compared to CRT-P. CRT was also projected to delay progression from one NYHA class to the other, and to reduce HF hospitalization rates.” – by Jennifer Byrne
Disclosure: The REVERSE study was funded by Medtronic. One researcher reports receiving research funding and consulting fees from Boston Scientific Corp., Medtronic and St. Jude Medical. Please see the study for a full list of all other researchers’ financial disclosures.
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