{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:39:53Z","timestamp":1792521593881,"version":"4.5.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>With evolving therapy for heart failure with reduced ejection fraction, the benefits of adding a defibrillator in patients undergoing cardiac resynchronization therapy (CRT) remain unclear, particularly for nonischemic cardiomyopathy (NICM). This study evaluates long-term survival among patients with NICM treated with CRT defibrillator (CRT-D) versus CRT pacemaker (CRT-P).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>DECIDE-CRT (Cardiac Resynchronization With or Without Defibrillator in Non-Ischemic Cardiomyopathy) is a multicenter cohort study across 170 US Veterans Affairs hospitals. We identified patients with NICM receiving primary-prevention CRT-P or CRT-D between January 1, 2006, and December 31, 2020. Using a propensity score approach, we applied inverse probability of treatment weighting to balance baseline characteristics between the CRT-P and CRT-D groups. An inverse probability of treatment weighting\u2013weighted Cox model estimated hazards for all-cause mortality. Secondary outcomes included generator replacement, device-related infections, hospitalization for heart failure, and ventricular arrhythmias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Of 16\u2009609 CRT recipients, 3965 met NICM primary-prevention criteria (CRT-D=3158; CRT-\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =807). At baseline, patients with NICM receiving CRT-P were much older, with more cardiovascular and noncardiovascular comorbidities compared with the CRT-D group. During the median follow-up of 5.2 years, the mortality rate for CRT-P versus CRT-D was 9.46 versus 9.21 per 100 person-years (rate ratio, 0.97 [95% CI, 0.71\u20131.13];\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.66). The adjusted hazard ratio for all-cause mortality using the inverse probability of treatment weighting-Cox model was 0.90 (95% CI, 0.71\u20131.13;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.34). There was no difference in adjusted hazard for heart failure hospitalization (hazard ratio, 1.27 [95% CI, 0.86\u20131.87]), while the CRT-D group had higher rates of generator replacement and device-related infections.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>This nationwide observational study from the Veterans Affairs Health system did not demonstrate a clear survival advantage with the addition of a defibrillator among patients with NICM receiving CRT although residual confounding cannot be excluded. Given the uncertainty surrounding the incremental benefit of the defibrillator in this setting, a randomized trial is needed to test the incremental value of CRT-D over CRT-P in NICM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circheartfailure.126.014213","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T09:00:18Z","timestamp":1786093218000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Resynchronization With or Without Defibrillator in Nonischemic Cardiomyopathy: A Nationwide Cohort Study (DECIDE-CRT)"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2841-6334","authenticated-orcid":true,"given":"Padmini","family":"Selvaganesan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8089-8073","authenticated-orcid":true,"given":"Mohamad","family":"Karnib","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center, OH (M.K., I.H., M.N.O., R.A., A.I., J.S., V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7805-0654","authenticated-orcid":true,"given":"Irfan","family":"Helmy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center, OH (M.K., I.H., M.N.O., R.A., A.I., J.S., V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5322-0902","authenticated-orcid":true,"given":"Yogesh N.V.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (Y.N.V.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Rashid","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (I.R., M.N.O., V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3205-6733","authenticated-orcid":true,"given":"Mohammed N.","family":"Osman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center, OH (M.K., I.H., M.N.O., R.A., A.I., J.S., V.S.)."},{"name":"Department of Cardiology, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (I.R., M.N.O., V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2904-6638","authenticated-orcid":true,"given":"Ram","family":"Amuthan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center, OH (M.K., I.H., M.N.O., R.A., A.I., J.S., V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8274-5660","authenticated-orcid":true,"given":"Amanda R.","family":"Vest","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cleveland Clinic Foundation, OH (A.R.V.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0086-4567","authenticated-orcid":true,"given":"Anselma","family":"Intini","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center, OH (M.K., I.H., M.N.O., R.A., A.I., J.S., V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2427-9504","authenticated-orcid":true,"given":"James C.","family":"Fang","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, University of Utah, Salt Lake City (J.C.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1471-7016","authenticated-orcid":true,"given":"John G.F.","family":"Cleland","sequence":"additional","affiliation":[{"name":"School of Cardiovascular &amp; Metabolic Health, University of Glasgow, United Kingdom (J.G.F.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1419-604X","authenticated-orcid":true,"given":"Jayakumar","family":"Sahadevan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center, OH (M.K., I.H., M.N.O., R.A., A.I., J.S., V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4225-3693","authenticated-orcid":true,"given":"Rosita","family":"Zakeri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, School of Cardiovascular Medicine and Sciences, James Black Centre, King\u2019s College London, United Kingdom (R.Z.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6543-8482","authenticated-orcid":true,"given":"Varun","family":"Sundaram","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Louis Stokes Cleveland Veterans Affairs Medical Center, OH (M.K., I.H., M.N.O., R.A., A.I., J.S., V.S.)."},{"name":"Department of Cardiology, University Hospitals Harrington Heart and Vascular Institute, Cleveland, OH (I.R., M.N.O., V.S.)."},{"name":"Health Services Research Center, University Hospitals Research &amp; Education Institute, Cleveland, OH (V.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001063"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euab232"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050496"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032423"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.018830"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1609758"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joa.2017.03.002"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1608029"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv186"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab560"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf655"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.3233\/SHTI190584"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-017-0580-8"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0000000000000864"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa043399"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.11.023"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euv212"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1111\/jce.15894"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.01.040"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.124.017246"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.05.054"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2023.09.008"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.116.003532"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrthm.2019.04.028"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2016.10.014"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.17153"}],"container-title":["Circulation: Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCHEARTFAILURE.126.014213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:00:33Z","timestamp":1792519233000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCHEARTFAILURE.126.014213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":27,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1161\/CIRCHEARTFAILURE.126.014213"],"URL":"https:\/\/doi.org\/10.1161\/circheartfailure.126.014213","relation":{},"ISSN":["1941-3289","1941-3297"],"issn-type":[{"value":"1941-3289","type":"print"},{"value":"1941-3297","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-01-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}