Abstract：
OBJECTIVE: To assess the association between the use of adaptive pacing on clinical and economic outcomes of cardiac resynchronization therapy (CRT) recipients in a real-world analysis.
BACKGROUND: The adaptivCRT (aCRT) algorithm was shown in prior subgroup analyses of prospective trials to achieve clinical benefits, but a large prospective trial showed nonsignificant changes in the endpoint of mortality or hospitalizations due to heart failure.
METHODS: CRT-implanted patients from the Optum Clinformatics database with ≥ 90 days of follow-up were included. Remote monitoring data were used to classify patients based on CRT setting-adaptive biventricular and left ventricular pacing (aCRT) vs standard biventricular pacing (Standard CRT). Inverse probability of treatment weighting was used to adjust for baseline differences between groups. Mortality, 30-day readmissions, health care use, and payer and patients\' costs were evaluated post-implantation.
RESULTS: This study included 2412 aCRT and 1638 Standard CRT patients (mean follow-up: 2.4 ± 1.4 years), with balanced baseline characteristics after adjustment. The aCRT group was associated with lower all-cause mortality rates (adjusted hazard ratio = 0.88 [95% confidence interval (CI):0.80, 0.96]), fewer all-cause 30-day readmissions (adjusted incidence rate ratio = 0.87 [CI:0.81, 0.94]), and fewer all-cause and HF-related inpatient, outpatient and emergency department visits. The aCRT cohort was also associated with lower all-cause outpatient payer-paid amounts and lower all-cause and HF-related inpatient and emergency department patient-paid amounts.
CONCLUSIONS: In this retrospective analysis of a large real-world cohort, the use of an adaptive CRT algorithm was associated with lower mortality rates, reduced health care resource use and lower payer and patient costs.
BACKGROUND: The adaptivCRT (aCRT) algorithm was shown in prior subgroup analyses of prospective trials to achieve clinical benefits, but a large prospective trial showed nonsignificant changes in the endpoint of mortality or hospitalizations due to heart failure.
METHODS: CRT-implanted patients from the Optum Clinformatics database with ≥ 90 days of follow-up were included. Remote monitoring data were used to classify patients based on CRT setting-adaptive biventricular and left ventricular pacing (aCRT) vs standard biventricular pacing (Standard CRT). Inverse probability of treatment weighting was used to adjust for baseline differences between groups. Mortality, 30-day readmissions, health care use, and payer and patients\' costs were evaluated post-implantation.
RESULTS: This study included 2412 aCRT and 1638 Standard CRT patients (mean follow-up: 2.4 ± 1.4 years), with balanced baseline characteristics after adjustment. The aCRT group was associated with lower all-cause mortality rates (adjusted hazard ratio = 0.88 [95% confidence interval (CI):0.80, 0.96]), fewer all-cause 30-day readmissions (adjusted incidence rate ratio = 0.87 [CI:0.81, 0.94]), and fewer all-cause and HF-related inpatient, outpatient and emergency department visits. The aCRT cohort was also associated with lower all-cause outpatient payer-paid amounts and lower all-cause and HF-related inpatient and emergency department patient-paid amounts.
CONCLUSIONS: In this retrospective analysis of a large real-world cohort, the use of an adaptive CRT algorithm was associated with lower mortality rates, reduced health care resource use and lower payer and patient costs.
摘要：
目的：在实际分析中评估适应性起搏对CRT受者临床和经济结果的影响。
背景：AdaptivCRTTM算法已在先前的前瞻性试验亚组分析中显示，以实现临床益处，但一项大型前瞻性试验显示,死亡率或心力衰竭住院的终点无显著变化.
方法：纳入OptumClinformatics®数据库中接受CRT植入且随访时间≥90天的患者。远程监测数据用于根据CRT设置对患者进行分类-自适应双室和左心室起搏（aCRT）与标准双心室起搏（标准CRT）。使用治疗加权的逆概率来调整组间的基线差异。死亡率,再入院30天,医疗保健利用，植入后评估支付者和患者费用。
结果：这项研究包括2,412名aCRT和1,638名标准CRT患者（平均随访：2.4±1.4年），调整后具有平衡的基线特征。aCRT组的全因死亡率较低(调整后的风险比=0.88[95%置信区间(CI):0.80,0.96])。减少全因30天再入院(调整后的发病率=0.87[CI：0.81，0.94])，减少了全因和HF相关的住院患者，门诊病人,急诊（ED）就诊。aCRT队列还与较低的全因门诊付款人支付金额和较低的全因和HF相关住院和ED患者支付金额相关。
结论：在对一个大型现实世界队列的回顾性分析中，使用自适应CRT算法与较低的死亡率相关，降低医疗资源利用率，和较低的付款人和病人成本。
背景：虽然心脏再同步治疗（CRT）可改善某些心力衰竭患者的生活质量和临床结局，有些患者对这种疗法没有反应。自适应CRT算法(aCRT)，如AdaptivCRTTM，已经开发的目标是提高CRT的有效性，因此，临床和经济结果。这项研究使用了一个大型行政索赔数据数据库-其中包含有关患者人口统计的信息，诊断,收到的医疗服务，死亡率,和成本数据-比较aCRT算法开启的CRT患者(aCRT组)和aCRT算法关闭的CRT患者(标准CRT组)的临床和经济结果。使用统计学方法来调整aCRT组和标准CRT组之间的基线差异。最终,发现aCRT组全因死亡风险较低，减少所有原因30天的再入院，更少的医院就诊(包括住院，门诊病人,和急诊室访问)，为特定类型的成本降低付款人和患者的成本。
背景：AdaptivCRTTM算法已在先前的前瞻性试验亚组分析中显示，以实现临床益处，但一项大型前瞻性试验显示,死亡率或心力衰竭住院的终点无显著变化.
方法：纳入OptumClinformatics®数据库中接受CRT植入且随访时间≥90天的患者。远程监测数据用于根据CRT设置对患者进行分类-自适应双室和左心室起搏（aCRT）与标准双心室起搏（标准CRT）。使用治疗加权的逆概率来调整组间的基线差异。死亡率,再入院30天,医疗保健利用，植入后评估支付者和患者费用。
结果：这项研究包括2,412名aCRT和1,638名标准CRT患者（平均随访：2.4±1.4年），调整后具有平衡的基线特征。aCRT组的全因死亡率较低(调整后的风险比=0.88[95%置信区间(CI):0.80,0.96])。减少全因30天再入院(调整后的发病率=0.87[CI：0.81，0.94])，减少了全因和HF相关的住院患者，门诊病人,急诊（ED）就诊。aCRT队列还与较低的全因门诊付款人支付金额和较低的全因和HF相关住院和ED患者支付金额相关。
结论：在对一个大型现实世界队列的回顾性分析中，使用自适应CRT算法与较低的死亡率相关，降低医疗资源利用率，和较低的付款人和病人成本。
背景：虽然心脏再同步治疗（CRT）可改善某些心力衰竭患者的生活质量和临床结局，有些患者对这种疗法没有反应。自适应CRT算法(aCRT)，如AdaptivCRTTM，已经开发的目标是提高CRT的有效性，因此，临床和经济结果。这项研究使用了一个大型行政索赔数据数据库-其中包含有关患者人口统计的信息，诊断,收到的医疗服务，死亡率,和成本数据-比较aCRT算法开启的CRT患者(aCRT组)和aCRT算法关闭的CRT患者(标准CRT组)的临床和经济结果。使用统计学方法来调整aCRT组和标准CRT组之间的基线差异。最终,发现aCRT组全因死亡风险较低，减少所有原因30天的再入院，更少的医院就诊(包括住院，门诊病人,和急诊室访问)，为特定类型的成本降低付款人和患者的成本。
