Heart failure & cardiomyopathiesMeta-analysis
Time-trend treatment effect of cardiac resynchronization therapy with or without defibrillator on mortality: a systematic review and meta-analysis
- Systematic review and meta-analysis of observational studies
- mostly retrospective
Authors' conclusion
The results of this systematic review of observational studies, mostly retrospective with meta-analysis, suggest that patients with CRT-D had a lower risk of mortality compared with CRT-P.
Study context
- Population
- CRT patients in studies comparing CRT with a pacemaker (CRT-P) and cardiac resynchronization therapy with a defibrillator (CRT-D) (PubMed, CENTRAL, Embase up to October 2021)
- Participants
- 128,030 patients · 26 observational studies
- Comparison
- CRT-D vs CRT-P
- CRT-Dn = 72,561
- CRT-Pn = 55,469reference
- Outcome
- All-cause mortality
Pooled result
As reported in the abstract
Adjusted hazard ratio
0.85
95% CI 0.76–0.94
P < 0.01
CRT-D vs CRT-P
adjusted HR 0.85 (95% CI 0.76–0.94); P < 0.01
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality, propensity-matched studies (subgroup) | 0.83 (0.80–0.87) | P < 0.001 | |
| All-cause mortality, non-ischaemic aetiology (subgroup) | 0.95 (0.79–1.15) | P = 0.19 | |
| All-cause mortality, over 75 years (subgroup) | 1.08 (0.96–1.21) | P = 0.17 | |
| 0.512Hazard ratio (log scale) |
Treatment effect by median year of inclusion
- Difference between studies released before 2015 and those thereafter
Patient characteristics over time
- CRT-P candidates getting older; prevalence of ischaemic aetiology increasing over time
Original publication
Time-trend treatment effect of cardiac resynchronization therapy with or without defibrillator on mortality: a systematic review and meta-analysis. Europace. Published 28 September 2023. doi:10.1093/europace/euad289
Summarised from the published abstract; every number is checked against it