Cardiac resynchronization therapy using pacemakers vs defibrillators in patients with nonischemic cardiomyopathy: The United States experience from 2007 to 2014.
Cardiac resynchronization therapy
Cost
Defibrillator
Mortality
Pacemaker
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
07
02
2019
pubmed:
21
4
2019
medline:
4
11
2020
entrez:
21
4
2019
Statut:
ppublish
Résumé
The impact of implantable defibrillator therapy on outcomes of patients with nonischemic cardiomyopathy (NICM) who receive a cardiac resynchronization therapy (CRT) device is controversial. The purpose of this study was to examine the outcomes of NICM patients who receive a CRT-pacemaker (CRT-P) vs CRT-defibrillator (CRT-D). Using 2007-2014 claims data for a 5% random sample of Medicare beneficiaries, we followed patients with NICM who received a CRT device (1236 CRT-P, 4359 CRT-D), excluding those with a prior history of ventricular arrhythmias with a primary outcome of all-cause mortality and secondary outcomes including time to first cardiac hospitalization and total medical costs. Propensity score matching and Cox proportional hazard models were used to balance patient characteristics between treatment groups. At 5 years, 2007 patients (36%) died and 3809 (68%) were hospitalized for any reason, whereas 2504 (45%) were hospitalized for cardiac causes. In the propensity score matched sample, the time to all-cause mortality (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.74-1.09), any hospitalization (HR 1.13; 95% CI 0.98-1.30), and cardiac hospitalization (HR 0.98; 95% CI 0.83-1.17) did not differ between matched CRT-P and CRT-D recipients. However, CRT-P recipients had significantly lower medical costs (difference ∼$20,000) and cardiac-related medical costs at 12 and 24 months. Although more expensive, defibrillator therapy is not associated with prolonged survival or decreased risk of hospitalization in CRT recipients with NICM. These results suggest that in patients with NICM and no previous history of ventricular arrhythmias, CRT-P devices should be considered. These findings have important clinical and economic implications.
Sections du résumé
BACKGROUND
The impact of implantable defibrillator therapy on outcomes of patients with nonischemic cardiomyopathy (NICM) who receive a cardiac resynchronization therapy (CRT) device is controversial.
OBJECTIVE
The purpose of this study was to examine the outcomes of NICM patients who receive a CRT-pacemaker (CRT-P) vs CRT-defibrillator (CRT-D).
METHODS
Using 2007-2014 claims data for a 5% random sample of Medicare beneficiaries, we followed patients with NICM who received a CRT device (1236 CRT-P, 4359 CRT-D), excluding those with a prior history of ventricular arrhythmias with a primary outcome of all-cause mortality and secondary outcomes including time to first cardiac hospitalization and total medical costs. Propensity score matching and Cox proportional hazard models were used to balance patient characteristics between treatment groups.
RESULTS
At 5 years, 2007 patients (36%) died and 3809 (68%) were hospitalized for any reason, whereas 2504 (45%) were hospitalized for cardiac causes. In the propensity score matched sample, the time to all-cause mortality (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.74-1.09), any hospitalization (HR 1.13; 95% CI 0.98-1.30), and cardiac hospitalization (HR 0.98; 95% CI 0.83-1.17) did not differ between matched CRT-P and CRT-D recipients. However, CRT-P recipients had significantly lower medical costs (difference ∼$20,000) and cardiac-related medical costs at 12 and 24 months.
CONCLUSION
Although more expensive, defibrillator therapy is not associated with prolonged survival or decreased risk of hospitalization in CRT recipients with NICM. These results suggest that in patients with NICM and no previous history of ventricular arrhythmias, CRT-P devices should be considered. These findings have important clinical and economic implications.
Identifiants
pubmed: 31004781
pii: S1547-5271(19)30357-1
doi: 10.1016/j.hrthm.2019.04.028
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1065-1071Informations de copyright
Copyright © 2019 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.