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CRT-P may be better option than CRT-D in nonischemic cardiomyopathy
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Among patients with nonischemic cardiomyopathy who require cardiac resynchronization therapy, a pacemaker may have comparable efficacy and more cost efficiency compared with a defibrillator, according to findings published in HeartRhythm.
Samir Saba, MD, FACC, and colleagues examined outcomes of patients with nonischemic cardiomyopathy who received a CRT pacemaker vs. a defibrillator.
“Both CRT-P and CRT-D provide resynchronization to the failing heart through low energy pacing impulses, but CRT-D can additionally deliver high-energy shock therapy to terminate life-threatening ventricular arrhythmias,” Saba, a cardiologist at the Heart and Vascular Institute in Pittsburgh, and colleagues wrote. “However, there are other major differences between these two types of implantable devices.”
The researchers analyzed claims data from a 5% random sample of Medicare beneficiaries between 2007 and 2014. The study included 1,236 patients with CRT-P and 4,359 patients with CRT-D and excluded patients with prior ventricular arrhythmias.
The primary outcome was all-cause mortality, with secondary outcomes including first cardiac hospitalization and total medical costs.
Propensity score matching and Cox proportional hazard models were used to balance patient characteristics between treatment groups, Saba and colleagues wrote.
At 5 years, the researchers found, 36% of patients died and 68% of patients were hospitalized for any reason. Of the patients in the study, 45% were hospitalized for cardiac causes.
In the propensity score-matched sample, the time to all-cause mortality (HR = 0.9; 95% CI, 0.74-1.09) and any hospitalization (HR = 1.13; 95% CI, 0.98-1.3) did not differ between the CRT-P and CRT-D groups, Saba and colleagues wrote. Cardiac hospitalization (HR = 0.98; 95% CI, 0.83-1.17) also did not differ between the groups.
CRT-P recipients had significantly lower medical costs (about $20,000 difference) and cardiac-related medical costs compared with CRT-D recipients at 1 year and 2 years, the researchers wrote.
According to Saba and colleagues, their data support greater use of CRT-P in patients, as it is associated with reduced costs and comparable outcomes.
“A pivotal randomized controlled trial of CRT-P versus CRT-D device therapy in eligible (nonischemic cardiomyopathy) patients is needed to conclusively answer this important question,” the researchers wrote. – by Earl Holland Jr.
Disclosures: Saba reports he receives research support from Boston Scientific and Medtronic. Please see the study for all other authors’ relevant financial disclosures.
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