Mode of death in advanced heart failure: The Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial

Peter Carson, Inder Anand, Christopher O'Connor, Brian Jaski, Jonathan Steinberg, Amy Lwin, Jo Ann Lindenfeld, Jalil Ghali, Jodi H. Barnet, Arthur M. Feldman, Michael R. Bristow

Research output: Contribution to journalArticle

177 Scopus citations

Abstract

OBJECTIVES: The aim of this study was to evaluate the mode of death in patients with advanced chronic heart failure (HF) and intraventricular conduction delay treated with optimal pharmacologic therapy (OPT) alone or OPT with biventricular pacing to provide cardiac resynchronization therapy (CRT) or CRT + an implantable defibrillator (CRT-D). BACKGROUND: Limited data are available on mode of death in advanced HF. No data have existed on mode of death in these patients who also have an intraventricular conduction delay and are treated with CRT or CRT-D. METHODS: Using prespecified definitions and source materials, seven cardiologists assessed mode of death among the 313 deaths that occurred in the Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial. RESULTS: A primary cardiac cause was present in 78% of deaths. Pump failure (44.4%) was the most common mode of death followed by sudden cardiac death (SCD) (26.5%). Compared with OPT, CRT-D significantly reduced the number of cardiac deaths (38%, p = 0.006), whereas CRT alone was associated with a non-significant 14.5% reduction (p = 0.33). Both CRT and CRT-D tended to reduce pump failure deaths (29%, p = 0.11 and 27%, p = 0.14, respectively). The CRT-D significantly reduced SCD (56%, p = 0.02), but CRT alone did not. CONCLUSIONS: Pump failure deaths are the predominant mode of death in patients with advanced HF and are modestly reduced by both CRT and CRT-D. Only CRT-D reduced SCD and thus produced a favorable effect on cardiac mortality.

Original languageEnglish (US)
Pages (from-to)2329-2334
Number of pages6
JournalJournal of the American College of Cardiology
Volume46
Issue number12
DOIs
StatePublished - Dec 20 2005

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    Carson, P., Anand, I., O'Connor, C., Jaski, B., Steinberg, J., Lwin, A., Lindenfeld, J. A., Ghali, J., Barnet, J. H., Feldman, A. M., & Bristow, M. R. (2005). Mode of death in advanced heart failure: The Comparison of Medical, Pacing, and Defibrillation Therapies in Heart Failure (COMPANION) trial. Journal of the American College of Cardiology, 46(12), 2329-2334. https://doi.org/10.1016/j.jacc.2005.09.016