University of Leicester
Browse
Heart-2015-Woods-1800-6.pdf (643.67 kB)

Individual patient data network meta-analysis of mortality effects of implantable cardiac devices

Download (643.67 kB)
journal contribution
posted on 2016-02-17, 10:49 authored by Alexander Julian Sutton, B. Woods, N. Hawkins, S. Mealing, W. T. Abraham, J. F. Beshai, H. Klein, M. Sculpher, C. J. Plummer, M. R. Cowie
Objective: Implantable cardioverter defibrillators (ICD), cardiac resynchronisation therapy pacemakers (CRT-P) and the combination therapy (CRT-D) have been shown to reduce all-cause mortality compared with medical therapy alone in patients with heart failure and reduced EF. Our aim was to synthesise data from major randomised controlled trials to estimate the comparative mortality effects of these devices and how these vary according to patients’ characteristics. Methods: Data from 13 randomised trials (12 638 patients) were provided by medical technology companies. Individual patient data were synthesised using network meta-analysis. Results: Unadjusted analyses found CRT-D to be the most effective treatment (reduction in rate of death vs medical therapy: 42% (95% credible interval: 32–50%), followed by ICD (29% (20–37%)) and CRT-P (28% (15–40%)). CRT-D reduced mortality compared with CRT-P (19% (1–33%)) and ICD (18% (7–28%)). QRS duration, left bundle branch block (LBBB) morphology, age and gender were included as predictors of benefit in the final adjusted model. In this model, CRT-D reduced mortality in all subgroups (range: 53% (34–66%) to 28% (−1% to 49%)). Patients with QRS duration ≥150 ms, LBBB morphology and female gender benefited more from CRT-P and CRT-D. Men and those <60 years benefited more from ICD. Conclusions: These data provide estimates for the mortality benefits of device therapy conditional upon multiple patient characteristics. They can be used to estimate an individual patient's expected relative benefit and thus inform shared decision making. Clinical guidelines should discuss age and gender as predictors of device benefits.

History

Citation

Heart, 2015, 101, pp. 1800-1806

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciences

Version

  • VoR (Version of Record)

Published in

Heart

Publisher

BMJ Publishing Group with British Cardiovascular Society

issn

1355-6037

eissn

1468-201X

Acceptance date

2015-06-18

Copyright date

2015

Available date

2016-02-17

Publisher version

http://heart.bmj.com/content/101/22/1800

Language

en

Usage metrics

    University of Leicester Publications

    Categories

    No categories selected

    Keywords

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC