medwireNews: The survival benefit of adding cardiac-resynchronization therapy (CRT) to an implantable cardioverter–defibrillator (ICD) is sustained for up to 14 years in people with heart failure with a reduced ejection fraction, show long-term follow-up data from the RAFT trial.
The trial, which recruited 1798 patients with New York Heart Association (NYHA) class II or III heart failure, a left ventricular ejection fraction of 30% or less, and an intrinsic QRS duration of 120 msec or more (or a paced QRS duration of 200 msec or more) from 34 centers, initially showed that adding CRT to an ICD was associated with significantly lower mortality at 5 years than using only an ICD.
In the current analysis, John Sapp (Dalhousie University, Halifax, Nova Scotia, Canada) and colleagues extend the follow-up period to a median 7.7 years among 1050 patients (mean age 67 years, 84% men) from the eight highest-enrolling participating sites. For those who survived, the median follow-up was 13.9 years.
The researchers report in The New England Journal of Medicine that the mortality rate was 71.2% among the 520 patients randomly assigned to receive CRT in addition to an ICD (CRT-D group), compared with 76.4% among the 530 patients assigned to receive ICD alone.
In addition, fewer patients in the CRT-D group than in the ICD group experienced the composite secondary outcome of death from any cause, heart transplantation, or implantation of a ventricular assist device, at 75.4% versus 77.7%.
Survival curves indicated that the times until death and the composite outcome were both significantly longer with CRT-D than with ICD, but the investigators note that “the event curves for the composite outcome appeared to begin to converge after 12 years.”
Sapp and co-authors conclude that their analysis “supports the durability of the improvement in survival among patients with heart failure, reduced left ventricular ejection fraction, and prolonged QRS duration who received a CRT-D device.”
They add: “The benefit with respect to mortality that we observed in this trial occurred despite the inclusion of patients who have been shown to derive less clinical benefit or no clinical benefit from implantation of a CRT-D, including those with atrial fibrillation and those with QRS morphologic features without left bundle-branch block or with less-widened QRS complexes.”
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