Imperial College London

ProfessorDarrelFrancis

Faculty of MedicineNational Heart & Lung Institute

Professor of Cardiology
 
 
 
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Contact

 

+44 (0)20 7594 3381d.francis Website

 
 
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Assistant

 

Miss Juliet Holmes +44 (0)20 7594 5735

 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Finegold:2013:10.1016/j.jacc.2013.07.080,
author = {Finegold, JA and Raphael, CE and Levy, WC and Whinnett, Z and Francis, DP},
doi = {10.1016/j.jacc.2013.07.080},
journal = {J Am Coll Cardiol},
pages = {2406--2413},
title = {Quantification of survival gain from cardiac resynchronization therapy: nonlinear growth with time, and greater gain in low-risk patients, make raw trial data an underestimate of real-world behavior.},
url = {http://dx.doi.org/10.1016/j.jacc.2013.07.080},
volume = {62},
year = {2013}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - OBJECTIVES: The goal of this study was to examine the impact of calculation-window duration on lifespan gain (as observed in trials) and on who gains most. BACKGROUND: The landmark trials of biventricular pacing (cardiac resynchronization therapy [CRT]) typically ran for <1 device battery life, and they may therefore underestimate lifespan benefit over longer durations. METHODS: We conducted a meta-analysis of biventricular pacing trials to calculate lifespan gained: first, within the duration of randomized controlled trial data up to 2 years; second, over a 5-year typical battery life; and third, over >1 battery life. Importantly, we applied the Gompertz method for age-related increase in mortality from non-CRT-preventable causes. RESULTS: Five landmark trials (COMPANION [Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure], CARE-HF (CArdiac REsynchronization-Heart Failure), MADIT-CRT [Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy], REVERSE [Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction], RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure)) provided data for 2 years (6,561 patients), with an average hazard ratio of 0.71. Lifespan gained across all trials increased nonlinearly with time from 0.1 month at 1 year, to 0.5 month at 2 years, and a projected 6.5 months at 5 years (65 times more than at 1 year). After multiple devices, it reached 14 months, involving on average 1.6 devices (i.e., 8.8 months per device implanted). Moreover, while over a short window (e.g., 2 years), lower-mortality patients may gain less than higher-mortality patients (1.4 vs. 2.3 months), their positions reverse by 15 years (16.0 vs. 13.7 months). CONCLUSIONS: Lifespan gain from biventricular pacing rises nonlinearly with time. Early on, higher-risk patients exhibit more gain, but later, lower-risk patients exhibit more gain. Quantifying ga
AU - Finegold,JA
AU - Raphael,CE
AU - Levy,WC
AU - Whinnett,Z
AU - Francis,DP
DO - 10.1016/j.jacc.2013.07.080
EP - 2413
PY - 2013///
SP - 2406
TI - Quantification of survival gain from cardiac resynchronization therapy: nonlinear growth with time, and greater gain in low-risk patients, make raw trial data an underestimate of real-world behavior.
T2 - J Am Coll Cardiol
UR - http://dx.doi.org/10.1016/j.jacc.2013.07.080
UR - https://www.ncbi.nlm.nih.gov/pubmed/23988700
VL - 62
ER -