January 01, 2011
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Survival after CRT-D, ICD implantation comparable outside vs. inside clinical trial setting

Saxon L. Circulation. 2010;doi:10.1161/CIRCULATIONAHA.110.960633.

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Patients treated with implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillators in a naturalistic practice had a favorable survival rate compared with patients from clinical trials, according to new data published in Circulation.

Researchers compared the outcomes of patients in device clinic settings (total n=124,450; ICD and cardiac resynchronization therapy defibrillators [CRT-D], n=116,222; CRT-D only, n=8,228) with those who regularly transmitted remote data from the device an average of four times monthly (n=69,556). Mean patient age was 67 ± 13 years, and device implantation was followed for an average of 28 ± 17 months.

Overall, 1- and 5-year survival rates were 92% and 68% in the ICD implantation arm, and 88% and 54% in the CRT-D device arm, with a survival rate for patients with CRT-only of 82% at 1 year and 48% at 5 years.

For patients treated with ICD and CRT-D who received remote follow-up on the network, 1- and 5-year survival rates were higher vs. those treated with ICD and CRT-D who received device follow-up in device clinics only (ICD HR=0.56; CRT-D HR=0.45; P<.0001).

“This is the largest report to date on survival after device implantation and finds that survival benefits observed over shorter follow-up intervals in clinical trials are maintained,” the researchers wrote in their study. “This information is particularly important because there are upfront risks and costs associated with device implantation.”

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