Cardiac resynchronization therapy with defibrillation (CRT-D) improves outcomes in heart failure (HF), but its long-term impact on hospitalization burden remains uncertain. This post hoc analysis of the MADIT-CRT trial compared hospitalization rates, duration of stay, and mortality between CRT-D and implantable cardioverter-defibrillator (ICD) therapy. The analysis was published in the Journal of the American Heart Association.

Extended follow-up data were analyzed to assess cardiovascular (CV), HF, and non-CV hospitalizations. Patients receiving CRT-D experienced lower overall hospitalization rates compared with ICD alone (37.9 vs 44.3 events per 100 patient-years; P=0.033). CV hospitalizations were significantly reduced (20.8 vs 28.3 events per 100 patient-years; P<0.001), as were HF hospitalizations (6.8 vs 11.6 events per 100 patient-years; P<0.001). No significant difference was observed in non-CV hospitalizations (17 vs 16 events per 100 patient-years; P=0.368).

Length of stay for CV hospitalizations was shorter in the CRT-D group (6.7±0.89 vs 7.7±0.68 days; P<0.001), including HF admissions (4.2±0.79 vs 4.8±0.58 days; P<0.001). No significant difference was observed in non-CV hospitalization length of stay (8.1 vs 7.0 days; P = 0.082). Hospitalization of any type was strongly associated with increased mortality (hazard ratio 8.97; 95% confidence interval 6.17–13.05; P<0.0001). Hospitalization of any type was associated with a markedly increased risk of death (HR 8.97; 95% CI 6.17–13.05; P<0.0001).

In extended follow-up of MADIT-CRT, treatment with CRT-D corresponded to fewer and shorter CV and HF hospitalizations compared with ICD therapy. Across the study population, experiencing hospitalization was associated with substantially higher mortality.