Heart failure & cardiomyopathies
Comorbidities and Clinical Response to Cardiac Resynchronization Therapy: Patient-Level Meta-Analysis from Eight Clinical Trials
Authors' conclusion
In a meta-analysis of patient-level data from eight major trials, the totality of evidence suggests that CRT reduces HFH and/or all-cause mortality even when several comorbid diseases are present.
Study context
- Population
- HF patients in 8 cardiac resynchronization therapy (CRT) trials, classified by number of comorbidities (AF, CAD, DM, hypertension): 0, 1–2 or ≥3
- Participants
- 6,324 patients8 RCTs
- Comparison
- CRT vs no CRT, by comorbidity burden
- Outcome
- Time to all-cause mortality; time to HFH or all-cause mortality
Methodological detailsBayesian hierarchical Weibull survival regression
- Bayesian hierarchical Weibull survival regression
Pooled result
As reported in the abstract
All-cause mortality, by comorbidity burden
CRT vs No CRTAdjusted hazard ratio (95% CrI)P value
Overall cohort
0.79(0.68–0.93)
P = 0.010No comorbidities (n = 970)
0.54(0.34–0.86)
1-2 comorbidities (n = 4052)
0.81(0.67–0.97)
≥3 comorbidities (n = 1302)
0.83(0.64–1.07)
Further pooled results
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| HFH or all-cause mortality, by comorbidity burdenCRTvs No CRTOverall cohort | 0.74 (0.65–0.84) | P = 0.001 | |
| HFH or all-cause mortality, by comorbidity burdenCRTvs No CRTNo comorbidities | 0.69 (0.50–0.94) | ||
| HFH or all-cause mortality, by comorbidity burdenCRTvs No CRT1-2 comorbidities | 0.77 (0.66–0.90) | ||
| HFH or all-cause mortality, by comorbidity burdenCRTvs No CRT≥3 comorbidities | 0.68 (0.55–0.82) | ||
| 0.512Adjusted hazard ratio (log scale) |
- Heart failure hospitalization (HFH) or all-cause mortality, by comorbidity burden: 95% CrI
- HFH or all-cause mortality, by comorbidity burden: no significant interaction between CRT and comorbidity burden: p = 0.081
Original publication
Comorbidities and Clinical Response to Cardiac Resynchronization Therapy: Patient-Level Meta-Analysis from Eight Clinical Trials. Eur J Heart Fail. Published 15 September 2023. doi:10.
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