Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review.
Finlay A. McAlister,Justin A. Ezekowitz,Nicola Hooton,Ben Vandermeer,Carol Spooner,Donna M Dryden,Richard L. Page,Mark A. Hlatky,Brian H. Rowe +8 more
TLDR
CRT reduces morbidity and mortality in patients with LV systolic dysfunction, prolonged QRS duration, and New York Heart Association class 3 or 4 symptoms when combined with optimal pharmacotherapy.Abstract:
ContextLeft ventricular (LV) systolic dysfunction causes substantial morbidity and mortality, even with optimal pharmacotherapy. Atrial-synchronized biventricular pacemakers (cardiac resynchronization therapy [CRT]) received US Food and Drug Administration (FDA) approval for use in selected patients with LV systolic dysfunction in 2001.ObjectiveTo summarize the current evidence base for the efficacy, effectiveness, and safety of CRT in patients with LV systolic dysfunction.Evidence AcquisitionA search of multiple electronic databases until November 2006 was supplemented by hand searches of reference lists of included studies and review articles, proceedings booklets from meetings, FDA reports, and contact with primary study authors and device manufacturers. A total of 14 randomized trials (4420 patients) were included for the CRT efficacy review, 106 studies (9209 patients) for the CRT effectiveness review, and 89 studies (9677 patients) reported safety outcomes with implantation of a CRT device.Evidence SynthesisAll patients in the CRT studies had LV systolic dysfunction (mean LV ejection fraction [LVEF] range, 21%-30%), prolonged QRS duration (mean range, 155-209 milliseconds), and 91% had New York Heart Association (NYHA) class 3 or 4 heart failure symptoms despite optimal pharmacotherapy. CRT improved LVEF (weighted mean difference, 3.0%; 95% confidence interval [CI], 0.9%-5.1%), quality of life (weighted mean reduction in Minnesota Living With Heart Failure Questionnaire, 8.0 points; 95% CI, 5.6-10.4 points), and functional status (improvements of ≥1 NYHA class were observed in 59% of CRT recipients in the randomized trials). CRT decreased hospitalizations by 37% (95% CI, 7%-57%), and all-cause mortality decreased by 22% (95% CI, 9%-33%). Implant success rate was 93.0% (95% CI, 92.2%-93.7%) and 0.3% of patients died during implantation (95% CI, 0.1%-0.6%). During a median 11-month follow-up, 6.6% (95% CI, 5.6%-7.4%) of CRT devices exhibited lead problems and 5% (95% CI, 4%-7%) malfunctioned.ConclusionsCRT reduces morbidity and mortality in patients with LV systolic dysfunction, prolonged QRS duration, and NYHA class 3 or 4 symptoms when combined with optimal pharmacotherapy. The incremental benefits of combined CRT plus implantable cardioverter-defibrillator devices vs CRT-alone devices in patients with LV systolic dysfunction remain uncertain.read more
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Janani Rangaswami,Vivek Bhalla,John E.A. Blair,Tara I. Chang,Salvatore P. Costa,Krista L. Lentine,Edgar V. Lerma,Kenechukwu Mezue,Mark E. Molitch,Wilfried Mullens,Claudio Ronco,W.H. Wilson Tang,Peter A. McCullough +12 more
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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.
Paul A. Heidenreich,Biykem Bozkurt,David Aguilar,Larry A. Allen,Joni J. Byun,Monica Colvin,Anita Deswal,Mark H. Drazner,Shannon M. Dunlay,Linda R. Evers,James C. Fang,Savitri Fedson,Gregg C. Fonarow,Salim S. Hayek,Adrian F. Hernandez,Prateeti Khazanie,Michelle M. Kittleson,Christopher S. Lee,Mark S. Link,Carmelo A. Milano,Lorraine C. Nnacheta,Alexander T. Sandhu,Lynne W. Stevenson,Orly Vardeny,Amanda R. Vest,Clyde W. Yancy +25 more
TL;DR: The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of patients with heart failure, with the intent to improve quality of care and align with patients' interests.
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TL;DR: An instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research is described and its use to determine the effect of rater blinding on the assessments of quality is described.
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The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions.
Sara H. Downs,Nick Black +1 more
TL;DR: It is shown that it is feasible to develop a checklist that can be used to assess the methodological quality not only of randomised controlled trials but also non-randomised studies and it is possible to produce a Checklist that provides a profile of the paper, alerting reviewers to its particular methodological strengths and weaknesses.
Journal ArticleDOI
The effect of cardiac resynchronization on morbidity and mortality in heart failure
John G.F. Cleland,Jean-Claude Daubert,Erland Erdmann,Nick Freemantle,Daniel Gras,Lukas Kappenberger,Luigi Tavazzi +6 more
TL;DR: Cardiac resynchronization has been shown to reduce symptoms and improve left ventricular function in patients with heart failure due to systolic dysfunction and cardiac dyssynchrony.
Journal ArticleDOI
Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure.
Michael R. Bristow,Leslie A. Saxon,John P. Boehmer,Steven K. Krueger,David A. Kass,Teresa De Marco,Peter E. Carson,Lorenzo DiCarlo,David L. DeMets,Bill G. White,Dale W DeVries,Arthur M. Feldman +11 more
TL;DR: In this paper, the authors tested the hypothesis that prophylactic cardiac-resynchronization therapy in the form of biventricular stimulation with a pacemaker with or without a defibrillator would reduce the risk of death and hospitalization among patients with advanced chronic heart failure and intraventricular conduction delays.