{"id":42470,"date":"2014-03-30T10:52:37","date_gmt":"2014-03-30T14:52:37","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&#038;p=42470"},"modified":"2014-03-30T10:52:37","modified_gmt":"2014-03-30T14:52:37","slug":"long-term-follow-up-from-madit-crt-guideline-implications","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2014\/03\/30\/long-term-follow-up-from-madit-crt-guideline-implications\/","title":{"rendered":"Long-Term Follow-Up from MADIT-CRT: Guideline Implications"},"content":{"rendered":"<p><i>CardioExchange\u2019s <b>John Ryan<\/b> interviews <b>Arthur J. Moss<\/b> about his research group\u2019s study of long-term survival for patients who received cardiac resynchronization therapy with a defibrillator (CRT-D) in the MADIT-CRT trial. The findings were presented at ACC.14 and <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1401426?query=featured_home\">published simultaneously in <\/a><\/i><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1401426?query=featured_home\">The New England Journal of Medicine<\/a>.<\/p>\n<p><b>THE STUDY<\/b><\/p>\n<p>Seven-year follow-up in the MADIT-CRT trial was tracked, on an intention-to-treat basis, for all 1691 surviving participants and, subsequently, for 854 participants who were enrolled in post-trial registries. The cumulative all-cause mortality rate among patients with left bundle-branch block (LBBB) was significantly lower in the CRT-D group than in the defibrillator-alone group (18% vs. 29%). However, in patients without LBBB, CRT-D had no benefit and showed possible harm.<b><i>\u00a0<\/i><\/b><\/p>\n<p><b>THE INTERVIEW<\/b><\/p>\n<p><b><i>Ryan:<\/i><\/b> <b>Your results are very impressive. Will they compel us to change our practice and offer CRT-D to patients who have asymptomatic or mild congestive heart failure?<\/b><\/p>\n<p><b><i>Moss:<\/i><\/b> On the basis of data from our prior studies and publications (<a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1009540\"><i>N Engl J Med<\/i> 2010; 363:2385<\/a>; <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa0906431\">MADIT-CRT<\/a>), CRT-D is already approved for patients with asymptomatic or mild heart failure, a reduced LV ejection fraction, and a left bundle-branch block (LBBB) conduction disturbance. The current findings published in the NEJM strengthen the guideline indications, given the significant reduction in all-cause mortality during long-term (7-year) follow-up with CRT-D treatment in these patients.<\/p>\n<p><b><i>Ryan:<\/i><\/b> <b>The 2013 heart failure guidelines list CRT as a class IIa recommendation for patients who have a &#8220;non-LBBB pattern with a QRS duration of &gt;150 msec.\u201d Given your findings, should this recommendation be revisited?<\/b><\/p>\n<p><b><i>Moss:<\/i><\/b> The 2013 heart failure guidelines should be revised because our original trial results from 2010 showed no benefit of CRT-D in reducing the incidence of heart failure in patients with a non-LBBB pattern even with a wide QRS duration &gt;150 msec. Findings from our current trial show no evidence of mortality reduction during long-term follow-up.<\/p>\n<p>&nbsp;<\/p>\n<p><b>Share your thoughts on Dr. Moss\u2019 analysis of the long-term results from MADIT-CRT.<\/b><\/p>\n<p>To view all of our coverage from the ACC meeting, go to our\u00a0<a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/voices\/acc-14-headquarters\/\"><b>ACC.14 Headquarters\u00a0page<\/b><\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Arthur J. Moss discusses his research group\u2019s study of long-term survival for patients who received cardiac resynchronization therapy with a defibrillator in the MADIT-CRT trial. <\/p>\n","protected":false},"author":400,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,14],"tags":[696,411,287,412],"class_list":["post-42470","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","category-heart-failure","tag-cardiac-resynchronization-therapy","tag-crt-d","tag-heart-failure-2","tag-madit-crt"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/42470","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\/400"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=42470"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/42470\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=42470"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=42470"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=42470"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}