Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration.
Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration.
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心脏再同步治疗与植入式除颤器联合治疗心力衰竭和宽 QRS 波时限的患者的疗效比较。
DOI：
10.1016/j.amjcard.2014.08.017
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Stukenborg,GeorgeJ
中科院分区：
文献类型：
--
作者：
Bilchick,KennethC;Stukenborg,GeorgeJ
多项临床试验已经证实，心脏再同步治疗与植入式心脏复律除颤器相结合，可以提高适当选择的患者的生存率并减轻心力衰竭症状。最近的指南扩大了适应症，将心力衰竭较轻的患者包括在内。本研究的目的是检查心脏再同步治疗与植入式心脏复律除颤器相结合在多大程度上可以改善符合 I 类或 IIa 类建议的美国医疗保险患者的生存率并降低心力衰竭住院风险。倾向评分方法用于评估医疗保险患者的生存和再住院结果。在符合 I 级建议的患者中，接受联合心脏再同步治疗的患者死亡风险显着降低（风险比 [HR] 0.83，95% 置信区间 [CI] 0.77 至 0.88，p <0.0001），再住院风险也显着降低（HR 0.88，95% CI 0.83 至 0.94，p <0.0001）。在符合IIa级推荐的患者中，联合心脏再同步治疗的患者死亡相对风险较低（HR 0.90，95% CI 0.85至0.96，p = 0.0015），但心力衰竭再住院风险无显着差异（HR 1.03，95% CI 0.97至1.10，p = 0.0015）。 0.2600）。总之，心脏再同步治疗与植入式心脏复律除颤器相结合，改善了符合 I 类标准的 Medicare 患者和大多数符合当前心力衰竭设备治疗指南中概述的 IIa 类标准的患者的生存率，尽管其效果低于最近试验中证明的效果。
Several clinical trials have established that cardiac resynchronization therapy in combination with an implantable cardioverter-defibrillator improves survival and alleviates heart failure symptoms in appropriately selected patients. Recent guidelines have expanded the indications to include patients with less severe heart failure. The aim of this study was to examine the extent to which cardiac resynchronization therapy in combination with an implantable cardioverter-defibrillator improves survival and reduces risk for heart failure hospitalization in United States Medicare patients who met class I or class IIa recommendations. Propensity score methods were used to assess survival and rehospitalization outcomes in Medicare patients. Among patients who met class I recommendations, those with combined cardiac resynchronization therapy had significantly lower risk for death (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.77 to 0.88, p <0.0001) and lower risk for rehospitalization (HR 0.88, 95% CI 0.83 to 0.94, p <0.0001). Among patients who met class IIa recommendations, the relative hazard of death for patients with combined cardiac resynchronization therapy was lower (HR 0.90, 95% CI 0.85 to 0.96, p = 0.0015), but there was no significant difference in the risk for rehospitalization for heart failure (HR 1.03, 95% CI 0.97 to 1.10, p = 0.2600). In conclusion, cardiac resynchronization therapy in combination with an implantable cardioverter-defibrillator resulted in improved survival among Medicare patients meeting class I criteria and most patients meeting class IIa criteria as outlined in the current guidelines for device-based therapy in heart failure, although the effect sizes were lower than those demonstrated in recent trials.
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影响因子：
5
作者：
Lau, Bryan;Cole, Stephen R.;Gange, Stephen J.
通讯作者：
Gange, Stephen J.
机械激活，疤痕和电时机对心脏重新同步治疗反应和临床结果的影响。
影响因子：
24
作者：
Bilchick, Kenneth C.;Kuruvilla, Sujith;Hamirani, Yasmin S.;Ramachandran, Raghav;Clarke, Samantha A.;Parker, Katherine M.;Stukenborg, George J.;Mason, Pamela;Ferguson, John D.;Moorman, J. Randall;Malhotra, Rohit;Mangrum, J. Michael;Darby, Andrew E.;DiMarco, John;Holmes, Jeffrey W.;Salerno, Michael;Kramer, Christopher M.;Epstein, Frederick H.
通讯作者：
Epstein, Frederick H.
影响因子：
5
作者：
Brookhart, M. Alan;Schneeweiss, Sebastian;Sturmer, Til
通讯作者：
Sturmer, Til
DOI：
10.1214/09-sts313
发表时间：
2010-02-01
期刊：
Statistical science : a review journal of the Institute of Mathematical Statistics
影响因子：
--
作者：
Stuart EA
通讯作者：
Stuart EA
影响因子：
37.8
作者：
Tracy, Cynthia M.;Epstein, Andrew E.;Varosy, Paul D.
通讯作者：
Varosy, Paul D.