Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction — a systematic review and meta‐analysis

Open Access
Publisher Website
Google Scholar
Abstract
1 Background: Randomised controlled trials generally suggest that cardiac resynchronisation improves outcomes in patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. Our objective was to provide a valid synthesis of the effects of CRT on mortality, major morbidity, quality of life and implantation success rates. 2 Methods: Systematic overview and meta‐analysis of randomised trials, both blinded and open, comparing cardiac resynchronisation with control. The primary outcome was all‐cause mortality, and secondary outcomes included hospitalisation for worsening heart failure, quality of life and implantation success rates. 3 Results: We identified 8 randomised trials which included 3380 patients and observed a total of 524 deaths. Follow‐up ranged from 1 month to a mean of 29.4 months. Most trials were of high quality, with centrally administered randomisation and few patients lost to follow‐up. CRT reduced mortality in these trials (odds ratio 0.72, 95% CI 0.59 to 0.88). In addition CRT reduced hospitalisation for worsening heart failure (odds ratio 0.55, 95% CI 0.44 to 0.68) and improved quality of life as measured by the Minnesota Living with Heart Failure Questionnaire (weighted mean difference −7.1, 95% CI −2.9 to −11.4). Implantation success rates in the trials were 87% or greater. 4 Conclusion: Cardiac resynchronisation in patients with heart failure characterised by dyssynchrony substantially reduces all‐cause mortality, major morbidity and improves quality of life.