CLINICAL EFFECTIVENESS OF CRT AND ICD THERAPY IN PATIENTS WITH HEART FAILURE BY RACE AND GENDER: FINDINGS FROM IMPROVE HF


Anne B. Curtis, M.D., University at Buffalo, Buffalo, NY, USA

Background: Clinical trials have demonstrated benefit for cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillator (ICD) therapies in patients with heart failure (HF) and reduced ejection fraction (EF), yet questions have been raised with regard to the benefit of device therapy for women and minorities.

Methods: IMPROVE HF was a prospective evaluation of an outpatient practice-based performance improvement intervention to increase the use of guideline-recommended care for eligible patients with HF. Data were analyzed by device status as well as sex and race among guideline-eligible patients where vital status (alive/dead) at 24 months was the outcome of interest. Multivariate GEE analyses of device therapy and sex/race were conducted adjusting for baseline patient and practice characteristics.

Results: Among 7748 eligible patients (5485 men, 71%), those with ICD/CRT-D were less likely to die at 2 years compared to those without (20.4% vs. 27.8%, odds ratio (OR) 0.66, 95% confidence intervals (CI) 0.58-0.74, p<0.0001). The benefit associated with ICD/CRT-D therapy was similar in men and women (OR 0.64, 95% CI 0.55-0.75, p<0.0001 and OR 0.65, 95% CI 0.53-0.79, p<0.0001, respectively). CRT-P/CRT-D therapy also showed a survival benefit (28.8% vs. 38.3%, OR 0.63, 95% CI 0.48-0.84, p=0.0017), with similar outcomes in men (OR 0.67, 95% CI 0.49-0.92, p=0.0133) and women (OR 0.53, 95% CI 0.31-0.91, p=0.0227). Regarding race, there was also benefit associated with ICD/CRT-D therapy (OR 0.64, 95% CI 0.0.52-0.79, P=0.0002 for 24-month mortality) and CRT-P/CRT-D therapy (OR 0.55, 95% CI 0.33-0.91, P=0.0222), which was of similar proportion in white, black, and other minority/not documented patients.

Conclusions: The use of guideline-directed CRT and ICD therapy was associated with substantially reduced 24 month mortality regardless of sex and race. Device therapies should be offered to all eligible HF patients, without restriction based on sex or race.