The RAFT trial randomized patients with NYHA II or III heart failure on optimal medical
therapy with EF ≤ 30% and widened QRS duration to implantation with cardiac resynchronization
defibrillator (CRT-D) or defibrillator alone (ICD) and demonstrated a reduction in
HF hospitalization and overall mortality with CRT-D over mean follow-up of 3.3 years.
The longer-term effects of CRT are less certain.
METHODS AND RESULTS
A chart review of patients who participated in the RAFT trial in Atlantic Canada was
performed. Patients from NB, PEI and NS were followed up based on the following composite
primary outcome: Any death, heart failure hospitalization, heart transplant and ventricular
assist device (VAD) implant in selected patients with complete data available. Secondary
outcomes included individual components of the primary outcome, along with cardiovascular
death (Death from HF, CAD or arrhythmia). Among 131 patients enrolled (80.7% male,
mean age = 65.3y) 66 were randomized to CRT-D and 63 patients to ICD. Follow-up was
available for 104 patients (51 in CRT-D and 53 in ICD subgroup). The mean period to
the primary endpoint was 11.3 (11.2-14.7). The primary outcome at the end of follow-up
occurred in 35 (66.8%) patients in the CRT-D subgroup and 41(77.3%) in the ICD subgroup
(HR 0.57, 95% CI= 0.35 - 0.91, p = 0.019). Cardiovascular death was the main driver
of the primary outcome (39.2% vs 56.5%, HR= 0.54, 95 CI- 0.030 - 0.94, p=0.031). There
was no significant difference in HF hospitalization between both groups.
The effect of CRT on mortality and HF hospitalization observed during the randomized
RAFT trial persisted during long-term follow-up. A national, multicentre follow-up,
long-term study of the RAFT trial is currently underway.