SUNDAY, Nov. 14 (HealthDay News) -- Canadian researchers report
that an implantable device called a resynchronization
therapy-defibrillator helps keep the left side of the heart pumping
properly, extending the life of heart failure patients.
Cardiac-resynchronization therapy, or CRT-D, also reduces heart
failure symptoms, such as edema (swelling) and shortness of breath,
as well as hospitalizations for some patients with moderate to
severe heart failure, the scientists added.
"The whole idea of the therapy is to try to resynchronize the heart," said lead researcher Dr. Anthony S.L. Tang, from the University of British Columbia in Vancouver.
It improves the heart's ability to contract and pump blood
throughout the body, he explained.
This study demonstrates that, in addition to symptom relief, the
CRT-D extends life and keeps heart failure patients out of the
hospital, Tang noted.
Tang added that patients will continue to need medical therapy
and an implantable cardioverter-defibrillator (ICD) in addition to
"We are saying people who are receiving good medical therapy and are now going to get a defibrillator, please go ahead and also do resynchronization therapy as well," he said. "This is worthwhile, because they will live longer and be more likely to stay out of the hospital."
The report is published in the Nov. 14 online edition of the
New England Journal of Medicine, to coincide with a scheduled presentation of the findings Sunday at the American Heart Association annual meeting in Chicago.
Tang's team randomly assigned 1,798 patients with mild or
moderate heart failure to have a CRT-D plus an ICD implanted or
only an ICD implanted.
Over 40 months of follow-up, the researchers found that those
who received both devices experienced a 29 percent reduction in
their symptoms, compared with patients who did not receive the
In addition, there was a 27 percent reduction in deaths and
heart failure hospitalizations among those who also had a CRT-D,
More than 22 million people worldwide, including 6 million
patients in the United States, suffer from heart failure. These
patients' hearts cannot adequately pump blood through the body. And
although deaths from heart disease have fallen over the last three
decades, the death rate for heart failure is rising, the
researchers said. Treating heart failure is also expensive, costing
an estimated $40 billion each year in the United States alone, they
In cardiac-resynchronization therapy, a stopwatch-sized device
is implanted in the upper chest to resynchronize the contractions
of the heart's upper chambers, called ventricles. This is done by
sending electrical impulses to the heart muscle. Resynchronizing
the contractions of the ventricles can help the heart pump blood
throughout the body more efficiently.
A CRT-D can cost as much $35,000, or roughly $7,500 more than an
ICD. About 650,000 Americans currently have either a CRT-D or an
ICD, according to Medtronic spokeswoman Catherine Peloquin.
The study was partly funded by Medtronic of Canada, the maker of
Dr. Arthur J. Moss, a professor of medicine at the University of
Rochester School of Medicine and Dentistry, in Rochester, N.Y., and
author of an accompanying journal editorial, said that "this is a
major advance in the treatment and prevention of heart
CRT-Ds will be used much more in the future, Moss said. "It's
also going to be used for patients who are on the waiting list for
heart transplants," he said. "It's also for patients who have
impaired heart function and it will prevent them from developing
Commenting on the study, Dr. Gregg Fonarow, American Heart
Association spokesman and a professor of cardiology at the
University of California, Los Angeles, said that
"cardiac-resynchronization therapy alone or together with an
implantable cardioverter-defibrillator has previously been shown to
reduce mortality and hospitalizations in patients with moderate to
severe heart failure."
Combined medical therapy and device therapy for patients with
mild, moderate and severe heart failure can substantially improve
survival and reduce the likelihood of hospitalization, he said.
"The cumulative benefits offered to heart failure patients by
evidence-based medication and device-based therapies are truly
The meeting also produced another potentially positive
development in heart failure treatment with the release on Sunday
of a trial of the drug eplerenone (Inspra), conducted in Europe and
led by Dr. Faiez Zannad of University of Nancy in Nancy, France.
This trial was also reported in the
New England Journal of Medicine.
In the study, more than 2,700 patients with chronic heart
failure but mild symptoms were randomly chosen to receive up to 50
milligrams of eplerenone daily or a placebo, in addition to
The results were so positive -- about 18 percent of patients on
eplerenone dying from cardiovascular causes or being hospitalized
for heart failure, versus almost 26 percent of those on a placebo
-- that the trial was stopped prematurely at 21 months, the
Eplerenone is from a class of drugs called aldosterone
antagonists, which also includes the cheaper medication
spironolactone, according to a journal editorial written by Dr.
Paul W. Armstrong of the University of Alberta, in Edmonton,
Zannad and his team "have added real value to the management of
heart failure" with the release of the study results, Armstrong
wrote. However, he questioned whether the results would have been
as positive in patients who already had pacemakers or implanted
defibrillators (as is recommended in current heart failure
guidelines). Armstrong also wondered if the additional cost of
eplerenone makes it a second choice for patients if they respond
well to the less expensive spironolactone.
For more information on heart failure, visit the
American Heart Association.
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