Long-Term Survival Benefit Associated with CRT-D Compared to ICD in HF in the RAFT Trial
SOURCE: Radcliffe Cardiology, Jordan Rance; Special Editor: Greg Guillory
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RAFT, a new extended follow-up trial (NCT00251251) showed insight into the survival benefit associated with coronary resynchronization therapy defibrillator (CRT-D) as compared to implantable cardioverter-defibrillator (ICD) in patients with heart failure.

 

Methodology:

  • The Resynchronization/Defibrillation for Ambulatory Heart Failure Trial (RAFT) is a randomized trial which aimed to compare the long-term outcomes of heart failure patients treated with optimal medical therapy and ICD, as compared to patients with optimal medical therapy and CRT. 
  • The study enrolled 1798 patients across 34 centres in Australia, Belgium, Canada, Denmark, Germany, Netherlands and Turkey. 1050 patients were included in the long-term survival trial. Median duration of follow-up was 7.7 years overall and those who survived had a median follow-up of 13.9 years. 
  • To be included in the trial, patients required at least a New York Heart Association (NYHA) Class II, with left ventricular ejection fraction (LVEF) ≥ 30%. Patients also required an intrinsic QRS duration of 120 miliseconds or greater, or a paced QRS duration of 200 miliseconds or greater to receive either an ICD alone, or a CRT-D. 
  • Patients with NYHA Class II or III heart failure were randomly assigned to receive either an ICD alone, or a CRT-D. Long-term outcomes were assessed at the eight highest-enrolling participating sites.
  • The primary outcome was all-cause death; the secondary outcome was a composite of all-cause death, heart transplantation or implantation of a ventricular assist device. 

 

Results:

  • RAFT Investigators found that death occurred in 405 of 530 patients (76.4%) who were assigned to the ICD group, and 370 of 520 patients (71.2%) assigned to the CRT-D group. 
  • Time until death appeared longer for patients assigned to receive CRT-D when compared to those assigned to receive an ICD, with an acceleration factor of 0.80; 95% confidence interval, and a P-value of 0.002.
  • A secondary outcome event was observed in 412 patients (77.7%) in the ICD group, and in 392 (75.4%) in the CRT-D group. Time until the composite endpoint was noted as longer in the CRT-D group in comparison to the ICD group (acceleration factor, 0.85; 95% CI, 0.74 to 0.98). 

 

The RAFT investigators summarised these findings in the conclusion of this research paper, stating that “Among[st] patients with a reduced ejection fraction, a widened QRS complex, and NYHA class II or III heart failure, the survival benefit associated with receipt of a CRT-D as compared with ICD appeared to be sustained during a median of nearly 14 years of follow-up.”

 

The study is sponsored by the Ottawa Heart Institute Research Corporation. 

 

References

Resynchronization/​Defibrillation for Ambulatory Heart Failure Trial (RAFT). ClinicalTrials.gov. Accessed 19 January, 2024. https://clinicaltrials.gov/study/NCT00251251.

Sapp, J, Sivakumaran, S, Redpath, C, et al. Long-Term Outcomes of Resynchronization–Defibrillation for Heart Failure. NEJM 2024; 390:212-220. Accessed 19 January, 2024. https://www.nejm.org/doi/full/10.1056/NEJMoa2304542?query=featured_home

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