Combining cardiac-resynchronization therapy with medication and an ICD reduces deaths and hospitalizations due to heart failure.
The results of the Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure (RAFT) trial were announced at the AHA Scientific Sessions 2010 and published in the NEJM in an article titled “Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure.”
In the RAFT trial, investigators “assigned 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 to receive either an ICD alone or an ICD [implantable cardioverter defibrillator] plus CRT” (cardiac-resynchronization therapy).
They reported that the primary endpoint (“death from any cause or hospitalization for heart failure”) occurred in about one-third (297 of 894) patients in the ICD—CRT group and in 40% (364 of 904 patients) in the ICD group. One hundred eighty-six (186) patients in the ICD–CRT group died (and 174 patients were hospitalized) as a result of heart failure; 236 patients in the ICD group died of heart failure. There were fewer adverse events (58) reported in the ICD group compared to the ICD-CRT group (124 adverse events).
The authors concluded that “Among patients with NYHA class II or III heart failure, a wide QRS complex, and left ventricular systolic dysfunction, the addition of CRT to an ICD reduced rates of death and hospitalization for heart failure. This improvement was accompanied by more adverse events.”
In an editorial accompanying the article in NEJM, Arthur Moss, MD, notes that “there was a 25% relative reduction in the primary end point of death from any cause or hospitalization for heart failure” in the ICD-RCT group. He also noted with interest that “improved survival did not become evident until about 2 years after the initiation of therapy in the ICD—CRT group, which suggests that the reduction in heart-failure events preceded the diminution in mortality.” Moss says that the RAFT trial confirms the results of previous trials (including MADIT-CRT and REVERSE) showing that “CRT had an increased benefit in patients with a QRS duration of 150 msec or more and in those with left bundle-branch block, as well as better efficacy in women than in men.” Together, these trials provid e” convincing evidence of the therapeutic prowess of CRT in appropriately selected patients with ischemic or nonischemic cardiomyopathy.”
In a news release from the AHA, lead author Anthony Tang, MD, an electrophysiologist at Royal Jubilee Hospital in Victoria, B.C., Canada, said that this study “conclusively demonstrated that this particular therapy [cardiac- resynchronization therapy], in addition to an ICD, will save lives… For patients, and for the physicians who treat them, this definitely showed that we can reduce hospitalization, suffering and dying.” Tang also said that “CRT alone, without a defibrillator, has been demonstrated to save lives. The defibrillator also has been shown to save lives. The big question is, when the two are added together does it still make sense?”
Here is video from the AHA of Anthony Tang, MD, discussing the results of the Resynchronization/defibrillation for Ambulatory heart Failure (RAFT) Trial.
Video Source: American Heart Association Science News