Barra, S;
Providência, R;
Duehmke, R;
Boveda, S;
Begley, D;
Grace, A;
Narayanan, K;
... Agarwal, S; + view all
(2018)
Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: A systematic review and proportional meta-analysis.
EP Europace
, 20
(3)
pp. 481-491.
10.1093/europace/eux094.
Preview |
Text
Bebiano Da Providencia E Costa_Cause of death in CRT patients 19022017.pdf - Accepted Version Download (1MB) | Preview |
Abstract
AIMS: The additional benefit of a defibrillator in cardiac resynchronization therapy (CRT) patients is a matter of debate. Cause-of-death analysis in a CRT population has been recently proposed as a useful approach to gain insight into this problem. We performed a systematic review and meta-analysis looking at cause of death in studies involving CRT subjects with (CRT-D) or without (CRT-P) a defibrillator. METHODS AND RESULTS: Literature search performed from inception to 31 March 2016 for relevant studies. Proportional and conventional meta-analyses were performed to obtain and compare causes of death in CRT-D vs. CRT-P patients, including sudden cardiac death (SCD), all-cause mortality, heart failure, cardiovascular, and non-cardiovascular mortalities. The systematic review included a total of 44 studies and 18 874 patients (13 248 receiving CRT-D and 5626 receiving CRT-P), representing 48 504 patient-years of follow-up. CRT-D recipients were younger, more often male, had lower NYHA class, less atrial fibrillation, more ischaemic heart disease and were more often on beta-blockers than those receiving CRT-P. There were an additional 42 deaths per 1000 patient-years in the CRT-P group compared with CRT-D (97 ± 9, 95% CI 79-115 vs. 55 ± 5, 95% CI 44-65, respectively), of which 35.7% were due to SCD (20 ± 2, 95% CI 15-24 vs. 5 ± 1, 95% CI 3-6) and the remaining 64.3% due to non-SCD. Of all deaths reported in CRT-D and CRT-P patients, 9.1% and 20.6% were due to SCD, respectively. The extent of SCD in CRT-P patients significantly increased in studies with higher percentage of males, ischaemic cardiomyopathy and NYHA class 3. CONCLUSION: Overall, compared with CRT-D patients, unadjusted mortality rate was almost two-fold higher in CRT-P recipients, with SCD representing one third of the excess mortality. Rate of SCD was significantly higher in certain subgroups (males, ischaemic cardiomyopathy, NYHA class 3), where a CRT-D may be of more pronounced benefit. This deserves further focused investigation.
| Type: | Article |
|---|---|
| Title: | Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: A systematic review and proportional meta-analysis |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/europace/eux094 |
| Publisher version: | http://dx.doi.org/10.1093/europace/eux094 |
| Language: | English |
| Additional information: | © The Author 2017. This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Cardiac resynchronization therapy , Implantable cardioverter-defibrillator , Cause of death , Sudden death , Heart failure , Mortality , Competing risk , Meta-analysis , Systematic review |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10051908 |
Archive Staff Only
 |
View Item |
