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Cause-of-death analysis in patients with cardiac resynchronization therapy with or without a defibrillator: A systematic review and proportional meta-analysis

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. Green open access

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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
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