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。
OBJECTIVE: To assess the association between use of adaptive pacing on clinical and economic outcomes of CRT recipients in a real-world analysis.
BACKGROUND: The AdaptivCRTTM 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 heart failure hospitalizations.
METHODS: CRT-implanted patients from the Optum Clinformatics® database with ≥90 days of follow-up were included. Remote monitoring data was 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, healthcare utilization, and payer and patient costs were evaluated post-implantation.
RESULTS: This study included 2,412 aCRT and 1,638 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 (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 (ED) visits. The aCRT cohort was also associated with lower all-cause outpatient payer-paid amounts and lower all-cause and HF-related inpatient and ED patient-paid amounts.
CONCLUSIONS: In this retrospective analysis of a large real-world cohort, use of an adaptive CRT algorithm was associated with lower mortality, reduced healthcare resource utilization, and lower payer and patient costs.
BACKGROUND: While cardiac resynchronization therapy (CRT) improves quality of life and clinical outcomes for certain heart failure patients, some patients do not respond to this therapy. Adaptive CRT algorithms (aCRT), such as AdaptivCRTTM, have been developed with the goal of improving effectiveness of CRT, and consequently, clinical and economic outcomes. This research study used a large database of administrative claims data - which contains information on patient demographics, diagnoses, healthcare services received, mortality, and cost data - to compare clinical and economic outcomes between CRT patients with the aCRT algorithm turned on (aCRT group) and CRT patients with the aCRT algorithm turned off (standard CRT group). Statistical methods were used to adjust for baseline differences between the aCRT group and standard CRT groups. Ultimately, the aCRT group was found to have a lower risk of all-cause mortality, fewer all-cause 30-day readmissions, fewer hospital visits (including inpatient, outpatient, and emergency department visits), and lower costs to payers and patients for specific types of costs.