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Heart failure & cardiomyopathiesCohort study

Cardiac Resynchronization With or Without Defibrillator in Nonischemic Cardiomyopathy: A Nationwide Cohort Study (DECIDE-CRT)

Circ Heart FailPublished

  • multicenter cohort study
  • 170 US Veterans Affairs hospitals
  • propensity score approach
  • inverse probability of treatment weighting
  • nationwide observational study
Read the original article ↗

Authors' conclusion

This nationwide observational study from the Veterans Affairs Health system did not demonstrate a clear survival advantage with the addition of a defibrillator among patients with NICM receiving CRT although residual confounding cannot be excluded. Given the uncertainty surrounding the incremental benefit of the defibrillator in this setting, a randomized trial is needed to test the incremental value of CRT-D over CRT-P in NICM.

Study context

Population
Patients with nonischemic cardiomyopathy (NICM) receiving primary-prevention CRT pacemaker (CRT-P) or CRT defibrillator (CRT-D) between January 1, 2006, and December 31, 2020met NICM primary-prevention criteria, of 16,609 cardiac resynchronization therapy (CRT) recipients · CRT-D 3,158 · CRT-P 807
Participants
3,965 patients
Exposure
CRT defibrillator versus CRT pacemaker
  • CRT-Pn = 807
  • CRT-Dn = 3,158reference

Main finding

Mortality rate · median follow-up of 5.2 years

Relative risk

0.97

95% CI 0.71–1.13

P = 0.66

By group

CRT-P vs CRT-D
RR 0.97 (95% CI 0.71–1.13); P = 0.66

As reported in the abstract

Observational data: associations, not effects.

Secondary outcomes

OutcomeEstimateP value
All-cause mortality · inverse probability of treatment weighting-Cox modeladjusted hazard ratio 0.90 (95% CI 0.71–1.13)P = 0.34
Heart failure hospitalization · no difference in adjusted hazardhazard ratio 1.27 (95% CI 0.86–1.87)

Generator replacement and device-related infections

the CRT-D group had higher rates of generator replacement and device-related infections

Baseline characteristics

patients with NICM receiving CRT-P were much older, with more cardiovascular and noncardiovascular comorbidities compared with the CRT-D group

Original publication

Cardiac Resynchronization With or Without Defibrillator in Nonischemic Cardiomyopathy: A Nationwide Cohort Study (DECIDE-CRT). Circ Heart Fail. Published 7 August 2026. doi:10.1161/circheartfailure.126.014213
Read the original article ↗PubMedCite RIS · BibTeX

Summarised from the published abstract; every number is checked against it