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JACC Heart Fail. 2017 May;5(5):388-392. doi: 10.1016/j.jchf.2017.02.018.

Impact of Current Versus Previous Cardiac Resynchronization Therapy Guidelines on the Proportion of Patients With Heart Failure Eligible for Therapy.

Author information

1
Division of Cardiology, University of Calgary, Calgary, Alberta, Canada.
2
Canadian VIGOUR Centre and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
3
Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina.
4
Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
5
Division of Cardiology, Northwestern University, Chicago, Illinois.
6
Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, California. Electronic address: gfonarow@mednet.ucla.edu.

Abstract

OBJECTIVES:

This study sought to ascertain the impact of heart failure (HF) guideline change on the number of patients eligible to undergo cardiac resynchronization therapy (CRT).

BACKGROUND:

The 2013 HF guideline of the American College of Cardiology Foundation and American Heart Association (ACCF/AHA) narrowed the recommendations for CRT. The impact of this guideline change on the number of eligible patients for CRT has not been described.

METHODS:

Using data from Get With The Guidelines-Heart Failure between 2012 and 2015, this study evaluated the proportion of hospitalized patients with HF who were eligible for CRT on the basis of historical and current guideline recommendations. The authors identified 25,102 hospitalizations for HF that included patients with a left ventricular ejection fraction (LVEF) ≤35% from 283 hospitals. Patients with a medical, system-related, or patient-related reason for not undergoing CRT were excluded.

RESULTS:

Overall, 49.1% (n = 12,336) of patients with HF, an LVEF ≤35%, and no documented contraindication were eligible for CRT on the basis of historical guidelines, and 33.1% (n = 8,299) of patients were eligible for CRT on the basis of current guidelines, a 16.1% absolute reduction in eligibility (p < 0.0001). Patients eligible for CRT on the basis of current guidelines were more likely to have CRT with an implantable cardioverter-defibrillator or CRT with pacing only placed or prescribed at discharge (57.8% vs. 54.9%; p < 0.0001) compared with patients eligible for CRT on the basis of historical guidelines.

CONCLUSIONS:

In this population of patients with HF, an LVEF ≤35%, and no documented contraindication for CRT, the current ACCF/AHA HF guidelines reduce the proportion of patients eligible for CRT by approximately 15%.

KEYWORDS:

cardiac resynchronization therapy; eligibility; guidelines; heart failure

PMID:
28449799
DOI:
10.1016/j.jchf.2017.02.018
[Indexed for MEDLINE]
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