{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:50:17Z","timestamp":1792615817410,"version":"4.5.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Data on the benefits of cardiac resynchronization therapy (CRT) in patients with severe heart failure symptoms are limited. We investigated the relative effects of CRT in patients with ambulatory New York Heart Association (NYHA) IV versus III functional class at the time of device implantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In this meta\u2010analysis, we pooled patient\u2010level data from the MIRACLE (Multicenter InSync Randomized Clinical Evaluation), MIRACLE\u2010ICD (Multicenter InSync Implantable Cardioversion Defibrillation Randomized Clinical Evaluation), and COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) trials. Outcomes evaluated were time to the composite end point of the first heart failure hospitalization or all\u2010cause mortality, and time to all\u2010cause mortality alone. The association between CRT and outcomes was evaluated using a Bayesian hierarchical Weibull survival regression model. We assessed if this association differed between NYHA III and IV groups by adding an interaction term between CRT and NYHA class as a random effect. A sensitivity analysis was performed by including data from RAFT (Resynchronization\u2010Defibrillation for Ambulatory Heart Failure). Our pooled analysis included 2309 patients. Overall, CRT was associated with a longer time to heart failure hospitalization or all\u2010cause mortality (adjusted hazard ratio [aHR], 0.79 [95% credible interval [CI], 0.64\u20130.99]; posterior probability or\n                      <jats:italic>P<\/jats:italic>\n                      =0.044), with a similar association with time to all\u2010cause mortality (aHR, 0.78 [95% CI, 0.59\u20131.03];\n                      <jats:italic>P<\/jats:italic>\n                      =0.083). Associations of CRT with outcomes were not significantly different for those in NYHA III and IV classes (ratio of aHR, 0.72 [95% CI, 0.30\u20131.27];\n                      <jats:italic>P<\/jats:italic>\n                      =0.23 for heart failure hospitalization\/mortality; ratio of aHR, 0.70 [95% CI, 0.35\u20131.34];\n                      <jats:italic>P<\/jats:italic>\n                      =0.27 for all\u2010cause mortality alone). The sensitivity analysis, including RAFT data, did not show a significant relative CRT benefit between NYHA III and IV classes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Overall, there was no significant difference in the association of CRT with either outcome for patients in NYHA functional class III compared with functional class IV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.031785","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T07:23:19Z","timestamp":1722410599000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Outcomes of Cardiac Resynchronization Therapy by New York Heart Association Class: A Patient\u2010Level Meta\u2010Analysis"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5014-4895","authenticated-orcid":false,"given":"Nishkala","family":"Shivakumar","sequence":"first","affiliation":[{"name":"Duke University School of Medicine","place":["Durham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5791-1954","authenticated-orcid":false,"given":"Daniel J.","family":"Friedman","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine","place":["Durham, USA"]},{"name":"Duke University School of Medicine","place":["Durham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-7007","authenticated-orcid":false,"given":"Marat","family":"Fudim","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine","place":["Durham, USA"]},{"name":"Duke University School of Medicine","place":["Durham, USA"]},{"name":"Wroclaw Medical University","place":["Wroclaw, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4805-1037","authenticated-orcid":false,"given":"William T.","family":"Abraham","sequence":"additional","affiliation":[{"name":"The Ohio State University","place":["Columbus, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1471-7016","authenticated-orcid":false,"given":"John G. F.","family":"Cleland","sequence":"additional","affiliation":[{"name":"Imperial College","place":["London, United Kingdom"]},{"name":"University of Glasgow","place":["Glasgow, UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9115-8051","authenticated-orcid":false,"given":"Anne B.","family":"Curtis","sequence":"additional","affiliation":[{"name":"University at Buffalo","place":["Buffalo, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4579-0216","authenticated-orcid":false,"given":"Michael R.","family":"Gold","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina","place":["Charleston, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0016-289X","authenticated-orcid":false,"given":"Valentina","family":"Kutyifa","sequence":"additional","affiliation":[{"name":"University of Rochester Medical Center","place":["Rochester, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9039-6023","authenticated-orcid":false,"given":"Cecilia","family":"Linde","sequence":"additional","affiliation":[{"name":"Karolinska University","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2785-1617","authenticated-orcid":false,"given":"James","family":"Young","sequence":"additional","affiliation":[{"name":"Lerner College of Medicine of Case Western Reserve University","place":["Cleveland, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3056-3114","authenticated-orcid":false,"given":"Anthony","family":"Tang","sequence":"additional","affiliation":[{"name":"Western University","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Olivas\u2010Martinez","sequence":"additional","affiliation":[{"name":"University of Washington","place":["Seattle, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lurdes Y.T.","family":"Inoue","sequence":"additional","affiliation":[{"name":"University of Washington","place":["Seattle, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian D.","family":"Sanders","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine","place":["Durham, USA"]},{"name":"Duke University","place":["Durham, USA"]},{"name":"Duke University School of Medicine","place":["Durham, USA"]},{"name":"Duke University School of Medicine","place":["Durham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3561-0146","authenticated-orcid":false,"given":"Sana M.","family":"Al\u2010Khatib","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine","place":["Durham, USA"]},{"name":"Duke University School of Medicine","place":["Durham, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0906431"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009540"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa013168"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa050496"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa032423"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.20.2685"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1210356"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000146336.92331.D1"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.08.027"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.07.795"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2020.0391"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12627"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2007.04.043"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht290"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.2524"}],"container-title":["Journal 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