Effects of Cardiac Resynchronization Therapy on Hospitalization in MADIT-CRT Long-Term Follow-Up

27 Feb 20264 min read0 viewsJournal Feed

GIST

Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundCardiac resynchronization therapy with defibrillation (CRT‐D) improves outcomes in heart failure.

The long‐term impact of CRT‐D on hospitalizations remains unknown.MethodsWe analyzed the MADIT‐CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) trial post hoc to assess the effects of CRT‐D versus implantable cardioverter‐defibrillator (ICD) on cardiovascular, heart failure (HF), and noncardiovascular hospitalizations. Hospitalization rates, length of stay, and mortality were compared during extended follow‐up.ResultsPatients receiving CRT‐D had lower rates of hospitalization compared with ICD (37.9 events per 100 patient‐years versus 44.3 events per 100 patient‐years,P=0.033).

Rates of cardiovascular hospitalizations (20.8 versus 28.3 events per 100 patient‐years;P<0.001) and heart failure hospitalizations (6.8 versus 11.6 events per 100 patient‐years;P<0.001) were lower with CRT‐D. There was no difference in noncardiovascular hospitalizations in the CRT‐D group compared with ICD (17 versus 16 events per 100 patient‐years,P=0.368).

Clinical Editorial

Strategic context and study aim

This report analyzes long-term outcomes from MADIT-CRT, focusing on how cardiac resynchronization therapy with defibrillation (CRT-D) compares with implantable cardioverter-defibrillator (ICD) in terms of hospitalization patterns across cardiovascular, heart failure (HF), and noncardiovascular domains.

Study design and population

Post hoc analysis of the MADIT-CRT trial, comparing CRT-D versus ICD.
Outcomes centered on hospitalization rates, length of stay, and mortality during extended follow-up.
Data reflect event rates per 100 patient-years and associated laboratory-style metrics for stay duration.

Interventions and exposure

Intervention: CRT-D device therapy.
Comparator: ICD therapy without CRT.

Key findings on hospitalization burden

Total hospitalization rate: CRT-D reduced all-cause hospitalizations compared with ICD (37.9 vs 44.3 events per 100 patient-years; P = 0.033).
Cardiovascular hospitalizations: Lower with CRT-D (20.8 vs 28.3 events per 100 patient-years; P < 0.001).
Heart failure hospitalizations: Significantly lower with CRT-D (6.8 vs 11.6 events per 100 patient-years; P < 0.001).
Noncardiovascular hospitalizations: No significant difference (17 vs 16 events per 100 patient-years; P = 0.368).

Hospitalization duration

Cardiovascular hospitalization length of stay: Shorter with CRT-D (6.7 ± 0.89 vs 7.7 ± 0.68 days; P < 0.001).
HF hospitalization length of stay: Shorter with CRT-D (4.2 ± 0.79 vs 4.8 ± 0.58 days; P < 0.001).
Noncardiovascular hospitalization length of stay: No significant difference (8.1 vs 7.0 days; P = 0.082).

Prognostic significance

Any hospitalization markedly elevated subsequent mortality risk (hazard ratio 8.97; 95% CI 6.17–13.05; P < 0.0001).
This association persisted regardless of hospitalization type reported.

Contextual interpretation and limitations

The data indicate that CRT-D is associated with lower frequency and shorter duration of cardiovascular hospitalizations, notably HF-related admissions, versus ICD alone.
Noncardiovascular hospitalization patterns were similar between groups.