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16th World Congress on Heart Disease

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Resynchronization Therapy Reduces Hospitalization
March 21, 2002

ATLANTA, Georgia (ACC) -- Recent analysis of data from the MIRACLE (Multicenter InSync Ran-domized Clinical Evaluation) study shows that cardiac resynchronization therapy (CRT) reduces the need for hospitalization and may improve survival, according to William T. Abraham, MD, from the University of Kentucky, who reported the findings at a news conference on Monday, March 18, 2002.

This is in addition to the therapy’s previously proven affects on improving exercise endurance and enhancing wellbeing, Dr. Abraham said. MIRACLE was the first large-scale, randomized, double-blind control trial of CRT for heart failure.

“In looking at measures of heart failure hospitalization, the risk of hospitalization for worsening heart failure was significantly reduced by 50 percent,” he said. “CRT was also associated with a significant reduction in hospital length of stay, with the average length of stay for the control group seven days and for the group receiving CRT 3.4 days.”

Looking at the total days of hospitalization for heart failure over six months, it was reduced by 77 percent, Dr. Abraham reported. Other measures of heart failure morbidity, such as worsening heart failure requiring the use of IV medication, also showed significant reduction.

“The combined endpoint of death or worsening heart failure requiring hospitalization was significantly reduced by 40 percent among those receiving CRT,” he said. “From this analysis, we can conclude that CRT reduces risk of heart failure hospitalization as well as other measures of worsening heart failure.”

However, he noted, observed improvement in combined measures of heart failure morbidity and all-cause mortality awaits confirmation by ongoing, large-scale morbidity and mortality trials.

“There was no significant difference between CRT and no CRT in terms of effect on mortality,” Dr. Abraham said, explaining that the study group was too small to assess mortality.

Dr. Abraham also reported on a small study from the University of Florence in Italy, conducted by Dr. Luigi Padeletti and colleagues, that observed the effects of CRT on cardiac structure, function, and neurohormones. Researchers found a significant correlation between reduction in tumor necrosis factor-a and improvement in the volume of blood the heart was able to pump with each contraction, as well as in quality of life.

“CRT was shown to improve patient outcomes and appears to reverse some of the adverse effects of heart failure related to structural changes and augmentation of the cytokine systems,” he said.

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