Impact of cardiac resynchronization therapy on hospitalizations in the Resynchronization-Defibrillation for Ambulatory Heart Failure trial.

BACKGROUND: This study reports the impact of cardiac resynchronization therapy (CRT) on hospitalizations in patients randomized to implantable cardioverter-defibrillator (ICD) or ICD-CRT in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT). METHODS AND RESULTS: Hospitalization rates and lengths of hospital stay were compared between the 2 groups. At the 18-month follow-up, the numbers of patients hospitalized for any cause were similar in the ICD (n=351, 38.8%) and ICD-CRT (n=331, 30.0%) groups. The number of patients hospitalized for heart failure was significantly lower in the ICD-CRT (n=101, 11.3%) compared with the ICD (n=141, 15.6%; P=0.003) group. The number of patients hospitalized for a device-related indication was similar in the ICD-CRT group (n=147, 16.4%) and ICD group (n=126, 13.9%; P=0.148). The total number of hospitalizations for any cause (n=1448 versus n=1553; P=0.042), any cardiovascular cause (n=667 versus n=790; P=0.017), and any heart failure cause (n=385 versus n=505; P<0.0001) was significantly lower in ICD-CRT group compared with the ICD group, whereas the number of hospitalizations for device-related causes was significantly higher in the ICD-CRT group compared with the ICD group (246 versus 159; P<0.001). Although the reduction in hospitalizations for heart failure in the CRT-ICD group was offset by an increased number of hospitalizations for device-related indications, the length of hospital stay for any cause was significantly shorter in the ICD-CRT group (8.83±13.30 days) compared with the ICD group (9.59±14.40 days; P=0.005). CONCLUSION: ICD-CRT therapy significantly reduces hospitalizations and total days in hospital in patients with New York Heart Association class II/III heart failure compared with ICD therapy despite increased admissions for device-related indications. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00251251.

Outcomes of second-line chemotherapy in patients with relapsed extensive small cell lung cancer.

INTRODUCTION: Extensive-disease small cell lung cancer (ED SCLC) is characterized by initial chemosensitivity, followed inevitably by relapse. The optimal role of additional chemotherapy at the time of progression is controversial. We reviewed the experience of all patients over a 5-year period with ED SCLC to describe outcomes of second-line chemotherapy. METHODS: Records of all patients registered at The Ottawa Hospital Regional Cancer Centre with ED SCLC were reviewed, and baseline prognostic factors, chemotherapy delivered, and treatment outcomes were extracted. Multivariate analyses were performed to determine the effect of second-line chemotherapy on survival. RESULTS: Of 192 patients who completed first-line chemotherapy, only 62 (32%) received second-line therapy; these patients were younger and fitter, and lived longer from the time of relapse (5.2 vs. 1.5 months). Second-line therapy was an independent predictor of survival. Benefit was observed in patients with relapse either before or after 60 days from the completion of first-line therapy. CONCLUSIONS: Second-line chemotherapy given at the time of relapse of ED SCLC seems to be associated with prolongation of survival, even in patients traditionally felt to have chemoresistant disease. The majority of patients, however, do not receive second-line therapy because of poor clinical status at relapse.