Daniel J Friedman1, Haikun Bao2, Erica S Spatz2, Jeptha P Curtis2, James P Daubert2, Sana M Al-Khatib2. 1. From Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., J.P.D., S.M.A.-K.); Duke Clinical Research Institute, Durham, NC (D.J.F., S.M.A.-K.); and Yale University School of Medicine, New Haven, CT (H.B., E.S.S., J.P.C.). daniel.friedman@duke.edu. 2. From Division of Cardiology, Duke University Hospital, Durham, NC (D.J.F., J.P.D., S.M.A.-K.); Duke Clinical Research Institute, Durham, NC (D.J.F., S.M.A.-K.); and Yale University School of Medicine, New Haven, CT (H.B., E.S.S., J.P.C.).
Abstract
BACKGROUND: A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and the data are conflicting. METHODS: We conducted inverse probability weighted analyses of 26 451 CRT-eligible (ejection fraction ≤35, QRS ≥120 ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230 ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes. We first tested the association between a prolonged PR interval and outcomes among patients stratified by device type. Next, we performed a comparative effectiveness analysis of CRT-D versus ICD among patients when stratified by PR interval. Using Medicare claims data, we followed up with patients up to 5 years for incident heart failure hospitalization or death. RESULTS: Patients with a PR≥230 ms (15%; n=4035) were older and had more comorbidities, including coronary artery disease, atrial arrhythmias, diabetes mellitus, and chronic kidney disease. After risk adjustment, a PR≥230 ms (versus PR<230 ms) was associated with increased risk of heart failure hospitalization or death among CRT-D (hazard ratio, 1.23; 95% confidence interval, 1.14-1.31; P<0.001) but not ICD recipients (hazard ratio, 1.08; 95% confidence interval, 0.97-1.20; P=0.17) (Pinteraction=0.043). CRT-D (versus ICD) was associated with lower rates of heart failure hospitalization or death among patients with PR<230 ms (hazard ratio, 0.79; 95% confidence interval, 0.73-0.85; P<0.001) but not PR≥230 ms (hazard ratio, 1.01; 95% confidence interval, 0.87-1.17; P=0.90) (Pinteraction=0.0025). CONCLUSIONS: A PR≥230 ms is associated with increased rates of heart failure hospitalization or death among CRT-D patients. The real-world comparative effectiveness of CRT-D (versus ICD) is significantly less among patients with a PR≥230 ms in comparison with patients with a PR<230 ms.
BACKGROUND: A prolonged PR interval is common among cardiac resynchronization therapy (CRT) candidates; however, the association between PR interval and outcomes is unclear, and the data are conflicting. METHODS: We conducted inverse probability weighted analyses of 26 451 CRT-eligible (ejection fraction ≤35, QRS ≥120 ms) patients from the National Cardiovascular Data Registry ICD Registry to assess the association between a prolonged PR interval (≥230 ms), receipt of CRT with defibrillator (CRT-D) versus implantable cardioverter defibrillator (ICD), and outcomes. We first tested the association between a prolonged PR interval and outcomes among patients stratified by device type. Next, we performed a comparative effectiveness analysis of CRT-D versus ICD among patients when stratified by PR interval. Using Medicare claims data, we followed up with patients up to 5 years for incident heart failure hospitalization or death. RESULTS:Patients with a PR≥230 ms (15%; n=4035) were older and had more comorbidities, including coronary artery disease, atrial arrhythmias, diabetes mellitus, and chronic kidney disease. After risk adjustment, a PR≥230 ms (versus PR<230 ms) was associated with increased risk of heart failure hospitalization or death among CRT-D (hazard ratio, 1.23; 95% confidence interval, 1.14-1.31; P<0.001) but not ICD recipients (hazard ratio, 1.08; 95% confidence interval, 0.97-1.20; P=0.17) (Pinteraction=0.043). CRT-D (versus ICD) was associated with lower rates of heart failure hospitalization or death among patients with PR<230 ms (hazard ratio, 0.79; 95% confidence interval, 0.73-0.85; P<0.001) but not PR≥230 ms (hazard ratio, 1.01; 95% confidence interval, 0.87-1.17; P=0.90) (Pinteraction=0.0025). CONCLUSIONS: A PR≥230 ms is associated with increased rates of heart failure hospitalization or death among CRT-D patients. The real-world comparative effectiveness of CRT-D (versus ICD) is significantly less among patients with a PR≥230 ms in comparison with patients with a PR<230 ms.
Authors: Stephen C Hammill; Mark S Kremers; Lynne Warner Stevenson; Paul A Heidenreich; Christine M Lang; Jeptha P Curtis; Yongfei Wang; Charles I Berul; Alan H Kadish; Sana M Al-Khatib; Ileana L Pina; Mary Norine Walsh; Michael J Mirro; Bruce D Lindsay; Matthew R Reynolds; Kathryn Pontzer; Laura Blum; Frederick Masoudi; John Rumsfeld; Ralph G Brindis Journal: Heart Rhythm Date: 2010-07-18 Impact factor: 6.343
Authors: Anthony S L Tang; George A Wells; Mario Talajic; Malcolm O Arnold; Robert Sheldon; Stuart Connolly; Stefan H Hohnloser; Graham Nichol; David H Birnie; John L Sapp; Raymond Yee; Jeffrey S Healey; Jean L Rouleau Journal: N Engl J Med Date: 2010-11-14 Impact factor: 91.245
Authors: Kenneth A Ellenbogen; Michael R Gold; Timothy E Meyer; Ignacio Fernndez Lozano; Suneet Mittal; Alan D Waggoner; Bernd Lemke; Jagmeet P Singh; Francis G Spinale; Jennifer E Van Eyk; Jeffrey Whitehill; Stanislav Weiner; Maninder Bedi; Joshua Rapkin; Kenneth M Stein Journal: Circulation Date: 2010-11-15 Impact factor: 29.690
Authors: Nikhil P Joshi; Matthew M Stopper; Jianqing Li; John F Beshai; Behzad B Pavri Journal: J Interv Card Electrophysiol Date: 2015-04-29 Impact factor: 1.900
Authors: J G Cleland; J C Daubert; E Erdmann; N Freemantle; D Gras; L Kappenberger; W Klein; L Tavazzi Journal: Eur J Heart Fail Date: 2001-08 Impact factor: 15.534
Authors: Andrew Brenyo; Valentina Kutyifa; Arthur J Moss; Andrew Mathias; Alon Barsheshet; Anne-Catherine Pouleur; Dorit Knappe; Scott McNitt; Bronislava Polonsky; David T Huang; Scott D Solomon; Wojciech Zareba; Ilan Goldenberg Journal: Heart Rhythm Date: 2013-05-25 Impact factor: 6.343
Authors: Valentina Kutyifa; Martin Stockburger; James P Daubert; Fredrik Holmqvist; Brian Olshansky; Claudio Schuger; Helmut Klein; Ilan Goldenberg; Andrew Brenyo; Scott McNitt; Bela Merkely; Wojciech Zareba; Arthur J Moss Journal: Circ Arrhythm Electrophysiol Date: 2014-06-24
Authors: T Ishikawa; K Kimura; N Miyazaki; O Tochikubo; T Usui; M Kashiwagi; M Ishii Journal: Pacing Clin Electrophysiol Date: 1992-11 Impact factor: 1.976
Authors: 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 Journal: J Am Coll Cardiol Date: 2015-12-15 Impact factor: 24.094
Authors: Matthew M Kalscheur; Ryan T Kipp; Matthew C Tattersall; Chaoqun Mei; Kevin A Buhr; David L DeMets; Michael E Field; Lee L Eckhardt; C David Page Journal: Circ Arrhythm Electrophysiol Date: 2018-01
Authors: Brett D Atwater; Kasper Emerek; Peter L Sørensen; Steen M Hansen; Zak Loring; Claus Graff; Christoffer Polcwiartek; Joseph Kisslo; Peter Søgaard; Daniel J Friedman Journal: Pacing Clin Electrophysiol Date: 2019-09-22 Impact factor: 1.976
Authors: Theodora Nikolaidou; Pierpaolo Pellicori; Jufen Zhang; Syed Kazmi; Kevin M Goode; John G Cleland; Andrew L Clark Journal: Clin Res Cardiol Date: 2017-09-15 Impact factor: 5.460
Authors: Ondřej Toman; Katerina Hnatkova; Peter Smetana; Katharina M Huster; Martina Šišáková; Petra Barthel; Tomáš Novotný; Georg Schmidt; Marek Malik Journal: Sci Rep Date: 2020-02-13 Impact factor: 4.379
Authors: Daniel Lapidot; Moshe Rav-Acha; Tali Bdolah-Abram; Rivka Farkash; Michael Glikson; Tal Hasin Journal: J Clin Med Date: 2022-02-26 Impact factor: 4.241