08 Dec CRT-D Reduced Heart Failure Hospitalizations in CKD Patients

Dr. Daniel Friedman

MedicalResearch.com Interview with:
Daniel Friedman, MD
Cardiology Fellow
Duke University Hospital
Durham, North Carolina

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Friedman: Cardiac resynchronization therapy (CRT) has been demonstrated to reduce heart failure hospitalizations, heart failure symptoms, and mortality in randomized clinical trials. However, these well-known trials either formally excluded or did not report enrollment of patients with more advanced chronic kidney disease (CKD), which we defined as a glomerular filtration rate of <45ml/minute. Since advanced CKD has been associated with an increased risk of adverse outcomes among patients with a variety of pacemakers and defibrillators, many have questioned whether the risks of CRT may outweigh the benefits in this population. Furthermore, many have hypothesized that the competing causes of morbidity and mortality among advanced CKD patients who meet criteria for CRT may mitigate clinical response and net benefit.

Our study assessed the comparative effectiveness of CRT with defibrillator (CRT-D) versus defibrillator alone in CRT eligible patients with a glomerular filtration rate of <60ml/minute (Stage III-V CKD, including those on dialysis). We demonstrated that CRT-D use was associated with a significant reduction in heart failure hospitalization or death in the overall population and across the spectrum of CKD. The lower rates of heart failure hospitalization or death was apparent in all subgroups we tested except for those without a left bundle branch block. Importantly, we also demonstrated that complication rates did not increase with increasing severity of CKD.

Dr. Friedman: MedicalResearch: What should clinicians and patients take away from your report?

Dr. Friedman: Our study supports the use of CRT in selected patients with advanced CKD. It is important to understand that the patients included in this study were those that were felt to be appropriate candidates for ICD implantation and that these results may not apply to all patients with advanced CKD – particularly those with a very high comorbidity burden and limited life expectancy. It is also important to note that while our study demonstrated that CRT was associated with a reduction in heart failure hospitalization and death, we did not have access to truly patient centered outcomes that would allow us to understand if patients actually felt better and had improved quality of life.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Friedman: These results need to be confirmed in prospective studies. These studies should include information on patient centered outcomes (quality of life, functional status, heart failure symptom burden) to help patients and physicians through the shared decision making process.

Citation:

Daniel J. Friedman, Jagmeet P. Singh, Jeptha P. Curtis, W.H. Wilson Tang, Haikun Bao, Erica S. Spatz, Adrian F. Hernandez, Uptal D. Patel, Sana M. Al-Khatib. Comparative Effectiveness of CRT-D Versus Defibrillator Alone in HF Patients With Moderate-to-Severe Chronic Kidney Disease. Journal of the American College of Cardiology, 2015; 66 (23): 2618 DOI: 10.1016/j.jacc.2015.09.097

Daniel Friedman, MD (2015). CRT-D Reduced Heart Failure Hospitalizations in CKD Patients 

Last Updated on December 8, 2015 by Marie Benz MD FAAD