1
Online Appendix
Supplementary Table 1. Logistic regression analysis assessing likelihood implantation of CRT-D
implantation (versus ICD).
Odds Ratio (95% CI)
P-value
Age, years
Sex
Male
Female
Race
White non-Hispanic
Black non-Hispanic
Hispanic
Other
QRS duration, ms
120-129
130-139
140-149
150-159
160-169
>=170
Intraventricular Conduction
LBBB
Non-LBBB
Non-Ischemic Cardiomyopathy
No
Yes-Within the past 9
months
Yes-Greater than 9 months
Ischemic Heart Disease
Atrial Fibrillation/Atrial Flutter
Ventricular Tachycardia
NYHA class
III
IV
Previous PCI
Previous CABG
Previous Valvular Surgery
Diabetes
Previous myocardial infarction
Sinus node function
Normal
Abnormal
Chronic Lung Disease
Cerebrovascular Disease
Cardiac Arrest
Hypertension
Syncope
CHF Duration
No
Less than 9 months
Greater than 9 months
AV conduction
Normal
1st degree heart block
2nd or 3rd degree (not paced)
EF %
CKD stage
0.99 ( 0.98 - 1.00 )
0.25
ref
0.92 ( 0.80 - 1.06 )
0.25
ref
0.68 ( 0.54 - 0.86 )
0.77 ( 0.57 - 1.04 )
1.19 ( 0.77 - 1.83 )
ref
1.71 ( 1.39 - 2.10 )
2.08 ( 1.69 - 2.57 )
2.16 ( 1.74 - 2.67 )
2.28 ( 1.83 - 2.84 )
2.17 ( 1.76 - 2.67 )
ref
0.47 ( 0.42 - 0.54 )
0.0036
<.0001
<.0001
ref
0.47 ( 0.42 - 0.54 )
<.0001
1.13 ( 0.88 - 1.46 )
0.80 ( 0.62 - 1.04 )
0.81 ( 0.70 - 0.95 )
0.83 ( 0.71 - 0.96 )
0.10
0.0086
0.0129
ref
1.16 ( 0.89 - 1.52 )
1.15 ( 1.00 - 1.33 )
0.91 ( 0.79 - 1.05 )
1.07 ( 0.86 - 1.33 )
1.01 ( 0.89 - 1.14 )
0.97 ( 0.84 - 1.13 )
0.28
0.06
0.19
0.55
0.88
0.73
ref
0.86 ( 0.74 - 0.99 )
1.06 ( 0.92 - 1.22 )
0.87 ( 0.75 - 1.01 )
0.91 ( 0.61 - 1.35 )
0.92 ( 0.79 - 1.07 )
0.88 ( 0.73 - 1.06 )
0.0374
0.41
0.07
0.63
0.28
0.17
ref
2.61 ( 1.95 - 3.48 )
2.78 ( 2.12 - 3.65 )
ref
0.92 ( 0.81 - 1.05 )
1.22 ( 0.87 - 1.71 )
0.99 ( 0.98 - 1.00 )
<.0001
0.20
0.15
2
IIIa
IIIb
IV
V
Dialysis
BUN Level
≤ 20
20-40
>40
Sodium Level
≤ 135
135-145
>145
Systolic BP
≤ 100
100-130
>130
Angiotensin converting enzyme
inhibitor
Amiodarone
Hydralazine
Angiotensin receptor blocker
Aspirin
Beta-blocker
Warfarin
Digoxin
Diuretic
Long acting nitrate
Clopidogrel
Ticlopidine
Statin
Dementia
Disability/frailty
EP operator ICD training
Board-certified EP/EP
fellowship
Surgeon
Other
Operator CRT volume
≤20 implants/year
>20 implants/year
Region
Other
New England
Atlantic
Central
Mountain
Pacific
Teaching status
Council of teaching hospitals
Teaching hospital
Not teaching hospital
Center CRT volume
≤20 implants/year
>20 implants/year
Beds set up and staffed
≤100
101-500
>500
Implant year
2006
2007
2008
2009
ref
1.12 ( 0.97 - 1.29 )
1.09 ( 0.87 - 1.36 )
0.78 ( 0.39 - 1.53 )
0.33
ref
0.81 ( 0.69 - 0.95 )
0.83 ( 0.66 - 1.03 )
0.0381
ref
0.99 ( 0.84 - 1.18 )
0.76 ( 0.47 - 1.22 )
0.50
ref
0.98 ( 0.77 - 1.25 )
0.93 ( 0.73 - 1.20 )
0.72
0.94 ( 0.82 - 1.07 )
0.33
1.02 ( 0.85 - 1.23 )
1.00 ( 0.77 - 1.31 )
1.16 ( 0.98 - 1.37 )
1.01 ( 0.88 - 1.15 )
1.09 ( 0.92 - 1.28 )
1.04 ( 0.89 - 1.21 )
1.06 ( 0.92 - 1.21 )
1.03 ( 0.88 - 1.19 )
1.17 ( 0.98 - 1.40 )
1.03 ( 0.88 - 1.20 )
0.66 ( 0.30 - 1.43 )
1.00 ( 0.87 - 1.14 )
1.04 ( 0.74 - 1.45 )
0.88 ( 0.71 - 1.08 )
0.83
1.00
0.09
0.88
0.33
0.65
0.44
0.75
0.08
0.74
0.29
0.94
0.84
0.23
ref
0.66 ( 0.42 - 1.05 )
0.67 ( 0.58 - 0.78 )
ref
1.96 ( 1.71 - 2.25 )
0.70 ( 0.50 - 1.00 )
1.11 ( 0.81 - 1.52 )
0.88 ( 0.77 - 1.02 )
Ref
1.15 ( 0.84 - 1.57 )
1.36 ( 1.07 - 1.7 )
Ref
1.04 ( 0.88 - 1.24 )
1.19 ( 1.00 - 1.42 )
ref
1.77 ( 1.50 - 2.09 )
ref
1.01 ( 0.76 - 1.34 )
1.05 ( 0.76 - 1.43 )
ref
1.11 ( 0.95 - 1.31 )
1.32 ( 1.12 - 1.56 )
1.67 ( 1.40 - 1.99 )
<.0001
<.0001
0.0052
0.09
<.0001
0.87
<.0001
3
EP Lab present in hospital
0.95 ( 0.84 - 1.09 )
0.46
4
Supplementary Table 2. Baseline patient, hospital, operator, and procedure characteristics in the cohort resulting from the inverse probability
weighted estimators analyses
ICD
CRT-D
% Standardized Difference
Age, years
Sex
Male
Female
Race
White non-Hispanic
Black non-Hispanic
Hispanic
Other
QRS duration, ms
120-129
130-139
140-149
150-159
160-169
>=170
Intraventricular Conduction
LBBB
Non-LBBB
Non-Ischemic Cardiomyopathy
No
Yes-Within the past 9
months
Yes-Greater than 9 months
Ischemic Heart Disease
Atrial Fibrillation/Atrial Flutter
Ventricular Tachycardia
NYHA class
III
IV
Previous PCI
Previous CABG
Previous Valvular Surgery
Diabetes
Previous myocardial infarction
Sinus node function
Normal
Abnormal
Chronic Lung Disease
Cerebrovascular Disease
Cardiac Arrest
Hypertension
Syncope
CHF Duration
No
Less than 9 months
Greater than 9 months
AV conduction
Normal
1st degree heart block
2nd or 3rd degree (not paced)
EF %
CKD stage
IIIa
IIIb
IV
V
75.7
75.7
0.28
66.1%
33.9%
66.1%
33.9%
0.01
-0.01
88.9%
6.5%
2.8%
1.8%
88.5%
6.2%
3.3%
2.1%
1.33
1.4
-2.76
-2.11
9.0%
15.6%
18.3%
16.6%
18.6%
22.0%
9.0%
15.4%
18.2%
17.7%
17.8%
21.9%
-0.02
0.49
0.16
-3.09
2.23
0.17
71.0%
29.0%
71.0%
29.0%
0.09
-0.09
65.8%
66.8%
-2.15
9.6%
9.2%
1.3
24.6%
69.0%
34.5%
16.6%
24.0%
69.2%
34.0%
17.8%
1.48
-0.59
1.05
-3.11
95.0%
5.0%
31.0%
44.0%
8.9%
41.6%
53.5%
95.0%
5.0%
31.7%
42.8%
8.4%
42.8%
54.0%
0.08
-0.08
-1.48
2.37
1.72
-2.48
-1.01
73.5%
26.5%
23.8%
16.6%
2.0%
79.5%
10.3%
74.6%
25.4%
24.5%
16.9%
1.8%
79.7%
10.1%
-2.53
2.53
-1.78
-0.72
1.49
-0.45
0.82
2.7%
24.5%
72.8%
2.9%
24.4%
72.7%
-0.7
0.09
0.17
68.5%
28.1%
3.4%
23.3
68.8%
28.0%
3.2%
23.3
-0.83
0.37
1.23
-0.05
48.8%
33.3%
12.4%
5.5%
49.5%
33.0%
12.0%
5.5%
-1.33
0.57
1.2
0.02
5
Dialysis
BUN Level
≤ 20
20-40
>40
Sodium Level
≤ 135
135-145
>145
Systolic BP
≤ 100
100-130
>130
Angiotensin converting enzyme
inhibitor
Amiodarone
Hydralazine
Angiotensin receptor blocker
Aspirin
Beta-blocker
Warfarin
Digoxin
Diuretic
Long acting nitrate
Clopidogrel
Ticlopidine
Statin
Dementia
Disability/frailty
EP operator ICD training
Board-certified EP/EP
fellowship
Surgeon
Other
Operator CRT volume
≤20 implants/year
>20 implants/year
Region
Other
New England
Atlantic
Central
Mountain
Pacific
Teaching status
Council of teaching hospitals
Teaching hospital
Not teaching hospital
Center CRT volume
≤20 implants/year
>20 implants/year
Beds set up and staffed
≤100
101-500
>500
Implant year
2006
2007
2008
2009
EP Lab present in hospital
4.9%
4.7%
0.71
19.3%
59.4%
21.3%
20.1%
59.2%
20.6%
-2.18
0.42
1.63
13.4%
84.7%
1.9%
13.7%
84.8%
1.5%
-0.95
-0.26
3.19
7.6%
43.9%
48.5%
6.9%
43.9%
49.2%
2.72
0.07
-1.48
55.9%
56.5%
-1.27
11.8%
5.2%
20.8%
64.6%
85.5%
29.2%
28.9%
78.5%
14.4%
22.6%
0.3%
65.8%
3.1%
7.9%
12.2%
5.3%
21.1%
66.9%
86.0%
28.1%
27.7%
79.3%
14.2%
22.8%
0.4%
65.9%
3.1%
7.7%
-1.2
-0.09
-0.63
-4.94
-1.28
2.48
2.62
-1.88
0.54
-0.44
-2.19
-0.33
0.19
0.78
81.7%
80.7%
2.48
1.1%
17.2%
1.2%
18.1%
-0.91
-2.28
52.9%
47.1%
53.2%
46.8%
-0.6
0.6
3.0%
4.5%
33.1%
46.1%
4.4%
8.9%
3.0%
4.2%
33.3%
47.0%
4.0%
8.5%
-0.11
1.1
-0.29
-1.9
2.13
1.61
27.7%
27.7%
44.6%
28.5%
27.6%
43.9%
-1.76
0.22
1.39
12.2%
87.8%
12.7%
87.3%
-1.46
1.46
5.4%
59.3%
35.4%
5.5%
58.8%
35.7%
-0.45
0.93
-0.74
24.4%
23.9%
25.9%
25.9%
69.1%
23.2%
25.0%
26.6%
25.2%
70.0%
2.83
-2.72
-1.66
1.59
-2.07
6
Supplementary Table 3. Multivariable adjusted subgroup analyses assessing the relation between CRT-D vs. ICD and outcomes across CKD stages in LBBB patients
CKD Stage
Outcome
HF
Hospitalization
or Death *
Death*
HF
Hospitalization
†
ESRD†
All
P Value
IIIa
0.74 ( 0.67 0.82 )
0.79 (0.69 0.91 )
<0.000
1
0.75 ( 0.64 0.88 )
0.83 ( 0.66 1.05 )
0.70 ( 0.61 0.80 )
0.93 (0.47 1.83 )
<0.000
1
0.0007
0.82
0.65 (0.54 0.79)
0.59 ( 0.31 1.14 )
P-value
0.0005
0.1122
<0.0001
0.12
IIIb
0.69 ( 0.57 0.83 )
0.73 ( 0.58 0.92 )
0.69 ( 0.54 0.88 )
0.98 ( 0.58 1.67 )
P-value
0.0002
0.0072
0.0024
0.94
IV
0.85 ( 0.62 1.17 )
0.81 ( 0.57 1.17 )
0.96 ( 0.64 1.44 )
1.56 ( 0.84 2.90 )
*Hazard Ratio (HR) of CRT vs. ICD in multivariate model (with adjustment for all the covariates)
†Subdistribution Hazard Ratio (SHR) of CRT vs. ICD in multivariate model (with adjustment for all the covariates)
P-Value
V
0.26
0.83 ( 0.50 1.37 )
0.74 ( 0.42 1.30 )
0.83
0.93 ( 0.47 1.83 )
0.32
0.16
P-Value
Pinteraction
0.47
0.67
0.29
0.88
0.82
0.34
0.11
7
Supplementary Table 4. Post hoc power calculations
Outcome
IV
HF Hospitalization or Death
0.8
Death
0.88
HF Hospitalization
0.12
CKD Class
V
0.3
0.29
0.07
8
Supplemental Figure 1. Unadjusted subgroup analyses assessing the relation between CRT-D vs. ICD and outcomes
across CKD stages. Hazard Ratios (HR) were calculated for the endpoints of HF hospitalization or death and death.
Subdistribution Hazard Ratios (SHR) were calculated for the endpoints of HF hospitalization and transition to ESRD.
Confidence intervals (CI) are presented with each point estimate.
9
Supplemental Figure 2. Forest plot depicting unadjusted subgroup analyses relating the association between device type
(CRT-D vs. ICD alone), baseline characteristics, and the primary outcome of HF hospitalization or death.