{"id":42458,"date":"2014-03-30T10:45:31","date_gmt":"2014-03-30T14:45:31","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=42458"},"modified":"2014-03-30T10:53:32","modified_gmt":"2014-03-30T14:53:32","slug":"madit-crt-long-term-followup-shows-survival-benefit-with-crt","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/03\/30\/madit-crt-long-term-followup-shows-survival-benefit-with-crt\/","title":{"rendered":"MADIT-CRT Long-Term Follow-Up Shows Survival Benefit with CRT-D"},"content":{"rendered":"<p>MADIT-CRT was an influential trial that showed a reduction in heart failure complications\u00a0\u2014 but not mortality\u00a0\u2014 when cardiac resynchronization therapy (CRT) was added to an implantable defibrillator in patients with mild heart failure who also had left bundle-branch block (LBBB). Patients in the trial were followed for 2.4 years, raising questions about the long-term effects of CRT. Now, a second look at 854 patients who participated in <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1401426?query=featured_home\">a follow-up study<\/a> suggests that over the long term, CRT may save lives in this population.<\/p>\n<p>Overall, there was a highly significant 41% reduction in death (<em>P<\/em>=0.001) associated with CRT therapy in the large subgroup of patients with LBBB. The mortality rate was different after 1 year and remained significant throughout follow-up. At 7 years, the mortality rate was 29% in the control group versus 18% in the CRT group. There was an even bigger difference in nonfatal heart failure events (<em>P<\/em>&lt;0.001). The benefits were remarkably consistent across a broad range of subgroups.<\/p>\n<p>However, the group of MADIT-CRT patients who did not have LBBB showed no reduction in either mortality or heart failure events associated with CRT. The authors wrote that this &#8220;lack of benefit of CRT in patients without left bundle-branch block was consistent, regardless of the QRS duration or ECG morphologic findings with respect to right bundle-branch block and an intraventricular conduction delay. Thus, at present, our data do not support early intervention with CRT in any subset of this population.&#8221;<\/p>\n<p>In <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1402676?query=featured_home\">an accompanying editorial<\/a>, Jeffrey Goldberger writes that the results should serve &#8220;as a strong impetus to pursue CRT in patients with mild heart failure with reduced ejection fraction and left bundle-branch block.&#8221;<\/p>\n<p>Arthur Moss, <a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/voices\/long-term-follow-up-from-madit-crt-guideline-implications\/\">responding in <em>CardioExchange<\/em><\/a>\u00a0to a question from John Ryan, said the 2013 heart failure guidelines, which recommend CRT for non-LBBB patients with a QRS duration of &gt;150 msec, needs to be revised.<\/p>\n<p>To view all of our coverage from the ACC meeting, go to our <a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/voices\/acc-14-headquarters\/\">ACC.14 Headquarters<\/a> page.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>MADIT-CRT was an influential trial that showed a reduction in heart failure complications\u00a0\u2014 but not mortality\u00a0\u2014 when cardiac resynchronization therapy (CRT) was added to an implantable defibrillator in patients with mild heart failure who also had left bundle-branch block (LBBB). Patients in the trial were followed for 2.4 years, raising questions about the long-term effects [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,14],"tags":[542,411,543,2217,758],"class_list":["post-42458","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","category-heart-failure","tag-crt","tag-crt-d","tag-icd","tag-madit","tag-resynchronization"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/42458","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=42458"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/42458\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=42458"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=42458"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=42458"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}