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- Title
Cardiac Resynchronization and Death From Progressive Heart Failure: A Meta-analysis of Randomized Controlled Trials.
- Authors
Bradley, David J.; Bradley, Elizabeth A.; Baughman, Kenneth L.; Berger, Ronald D.; Calkins, Hugh; Goodman, Steven N.; Kass, David A.; Powe, Neil R.
- Abstract
Context: Progressive heart failure is the most common mechanism of death among patients with advanced heart failure. Cardiac resynchronization, a pacemaker-based therapy for heart failure, enhances cardiac performance and quality of life, but its effect on mortality is uncertain. Objective: To determine whether cardiac resynchronization reduces mortality from progressive heart failure. Data Sources: MEDLINE (1966-2002), EMBASE (1980-2002), the Cochrane Controlled Trials Register (Second Quarter, 2002), The National Institutes of Health ClinicalTrials.gov database, the US Food and Drug Administration Web site, and reports presented at scientific meetings (1994-2002). Search terms included pacemaker, pacing, heart failure, dual-site, multisite, biventricular, resynchronization, and left ventricular preexcitation. Study Selection: Eligible studies were randomized controlled trials of cardiac resynchronization for the treatment of chronic symptomatic left ventricular dysfunction. Eligible studies reported death, hospitalization for heart failure, or ventricular arrhythmia as outcomes. Of the 6883 potentially relevant reports initially identified, 11 reports of 4 randomized trials with 1634 total patients were included in the meta-analysis. Data Extraction: Trial reports were reviewed independently by 2 investigators in an unblinded standardized manner. Data Synthesis: Follow-up in the included trials ranged from 3 to 6 months. Pooled data from the 4 selected studies showed that cardiac resynchronization reduced death from progressive heart failure by 51% relative to controls (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.25-0.93). Progressive heart failure mortality was 1.7% for cardiac resynchronization patients and 3.5% for controls. Cardiac resynchronization also reduced heart failure hospitalization by 29% (OR, 0.71; 95% CI, 0.53-0.96) and showed a trend toward reducing all-cause mortality (OR, 0.77; 95% CI, 0.51-1.18). Cardiac resynchronization was...
- Subjects
UNITED States; HEART failure; HEART disease related mortality; MORTALITY; CLINICAL trials; DEATH; MEDICAL research
- Publication
JAMA: Journal of the American Medical Association, 2003, Vol 289, Issue 6, p730
- ISSN
0098-7484
- Publication type
Article
- DOI
10.1001/jama.289.6.730