Cleland JGF et al. (2006) Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the Cardiac Resynchronization-Heart Failure (CARE-HF) trial extension phase]. Eur Heart J 27: 1928–1932

The Cardiac Resynchronization in Heart Failure (CARE-HF) trial investigated the benefits of cardiac resynchronization therapy (CRT) in patients with persistent moderate or severe symptoms of heart failure. This open-label randomized trial assigned patients to either medical therapy alone (n = 404) or medical therapy with implantation of a CRT device (n = 409). After a mean follow-up of 29.4 months, CRT produced benefits over medical therapy alone in terms of reductions in morbidity and mortality, as well as improving cardiac function, symptoms and quality of life.

The initial expense of CRT is higher than that of medical therapy, and implantation is associated with some morbidity; however, CRT has previously been shown to be cost-effective. The CARE-HF trial was extended for a further 8 months after completion of the main study, to determine whether the benefits of CRT remain over the long term. Over a mean follow-up of 37.4 months, the mortality in the medical therapy group was 38.1%, compared with 24.7% in the CRT group. The authors calculate that CRT would result in 1 additional patient being alive at 2 years for every 13 patients in whom device implantation is attempted, rising to 1 in every 9 at 3 years. The decrease in mortality in the CRT group resulted from a reduction in sudden death and in death caused by worsening heart failure. Results from the CARE-HF trial extension demonstrate that the benefits of CRT persist and might even increase over time.