Comparison of current German and European practice in cardiac resynchronization therapy: lessons from the ESC/EHRA/HFA CRT Survey II

Lawin, Dennis; Israel, Carsten W.; Linde, Cecilia; Normand, Camilla; Dickstein, Kenneth; Lober, Christiane; Gitt, Anselm K.; Hindricks, Gerhard; Stellbrink, Christoph; Hfa,

doi:10.1007/s00392-019-01574-z

Cited by 4 publications

(5 citation statements)

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“…Of the countries participating in CRT Survey II eleven have published national publications benchmarking their countries data against the total cohort. [48][49][50][51][52][53][54][55][56][57][58] Overall, patient selection and guideline adherence was similar in the 42 participating countries. However, these publications have highlighted some interesting differences.…”

Section: National Publications From Crt Survey IImentioning

confidence: 99%

“…Croatia, Bulgaria, Poland, Switzerland and Germany all reported higher co-morbidities in their CRT population compared with the total cohort. 52,[54][55][56][57] Possible explanations for the higher rate of comorbidities in patients in Germany is speculated to be a reluctance in other European countries to implant CRT in 'sicker' patients. In Bulgaria patients also appear to be referred later for a CRT device as more patients were in NYHA Class III or IV.…”

Section: National Publications From Crt Survey IImentioning

confidence: 99%

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Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II

et al. 2020

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Aims Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure (HF) and electrical dyssynchrony. The European Society of Cardiology (ESC) Guidelines provide evidence-based recommendations indicating optimal patient selection for CRT implantation in both the 2013 European Heart Rhythm Association (EHRA) and the 2016 Heart Failure Association (HFA) Guidelines. We assessed the adherence to guidelines and identified factors associated with guideline adherence. Methods and results In 2016, the HFA and EHRA conducted the CRT Survey II in 42 ESC countries. The data collected were sufficient to evaluate adherence to guidelines in 8021 patients. Of these, 67% had a Class I guideline indication for CRT implantation, which was significantly correlated with female gender (1.70, P < 0.0001), age <75 years (1.55, P < 0.0001), non-ischaemic HF aetiology (1.22, P < 0.0001), and elective admission (1.87, P < 0.0001). A further 26% of implants had a Class IIa indication, 5% IIb and only 2% a contraindication to CRT—a Class III indication. Patients implanted under Level IIa indications were much more likely to have more comorbidities than patients implanted under Level I indications. However, there were large variations in guideline adherence between ESC countries. Conclusion Implanters in ESC member states demonstrate a high degree of adherence to ESC guidelines with 98% of implants having a documented Class I, IIa or IIb indication. Cardiac resynchronization therapy implantation without a Class I indication was more likely in men, patients age ≥75 years, with HF of ischaemic origin and in patients admitted to hospital acutely.

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Section: National Publications From Crt Survey IImentioning

confidence: 99%

Section: National Publications From Crt Survey IImentioning

confidence: 99%

Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II

et al. 2020

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“…Chronic heart failure (CHF) is the major cause of mortality and morbidity in western society [1]. In patients with CHF and left bundle branch block (LBBB) with a QRS width of > 130 ms, cardiac resynchronization therapy (CRT) is an established therapy option with proven beneficial outcome [1,2]. Despite improvement of implantation efficiency and device technology, a non-responder rate between 20 and 50% is still evident [3,4].…”

Section: Introductionmentioning

confidence: 99%

Significance of myeloperoxidase plasma levels as a predictor for cardiac resynchronization therapy response

et al. 2020

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Objectives This study aimed to determine if changes in myeloperoxidase (MPO) levels correlate with response to cardiac resynchronization therapy (CRT) and the potential role of MPO as a predictor of response to CRT. Background CRT is a well-established treatment option in chronic heart failure (CHF) with 50–80% of patients benefiting. Inflammation and oxidative stress play a key role in CHF pathophysiology. Previous studies have demonstrated increased levels of MPO in CHF patients, but the correlation with CRT response remains incompletely understood. Methods Fifty-three patients underwent CRT implantation. During follow-up, patients were divided into two groups, responders and non-responders to CRT, based on improved physical capacity and NYHA classification. Levels of MPO and NT-pro-brain-natriuretic-peptide (NT-proBNP) were determined prior to implantation, 30 and 90 days after. Physical capacity, including a 6-min walking-test, NYHA class, and LVEF were evaluated at baseline and during follow-up. Results Thirty-four patients (64%) responded to CRT, showing improved physical capacity and LVEF. All responders revealed a significant decrease of MPO levels (503.8 ng/ml vs. 188.4 ng/ml; p < 0.001). Non-responding patients did not show any significant changes in clinical parameters or MPO levels (119.6 ng/ml vs. 134.3 ng/ml; p = 0.672) during follow-up. At baseline, physical capacity and NYHA class, as well as MPO levels differed significantly between both groups (p < 0.001). A ROC analysis identified an MPO cut-off value for response to CRT of 242 ng/ml with a sensitivity of 93.5% and specificity of 71.4%. There was a strong correlation between MPO and improvement of LVEF (Spearman’s rho: − 0.453; p = 0.005) and physical capacity (Spearman’s rho: − 0.335; p = 0.042). Conclusions Response to CRT and course of MPO levels correlate significantly. MPO levels differ between responders and non-responders prior to CRT, which may indicate an additional value of MPO as a predictor for CRT response. Further randomized studies are required to confirm our data in larger patient cohorts.

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“…Finally, ICD and CRT implantations in registry patients with higher comorbidities are safe procedures with a comparable pattern in terms of device type although implantation of more electrodes bears an overall higher risk for complications. The overall complication rate was lower than in RCT reflecting the broader experience with complex cardiac devices nowadays 27 . Remote monitoring of ICDs has not yet shown consistent evidence in reducing mortality and impact on quality of life 28,29 .…”

Section: Discussionmentioning

confidence: 91%

“…The overall complication rate was lower than in RCT reflecting the broader experience with complex cardiac devices nowadays. 27 Remote monitoring of ICDs has not yet shown consistent evidence in reducing mortality and impact on quality of life. 28,29 The nonstandardized questions in the registry confirm a high acceptance of the device and safetyfeeling by telemetric surveillance.…”

Section: Discussionmentioning

confidence: 99%

Selection and outcome of implantable cardioverter‐defibrillator patients with and without cardiac resynchronization therapy: Comparison of 4384 patients from the German Device Registry to randomized controlled trials

Köbe¹,

Willy²,

Senges

et al. 2022

Cardiovasc electrophysiol

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Background Registry data add important information to randomized controlled trials (RCT) on real‐life aspects of implantable cardioverter‐defibrillator (ICD) patients with and without cardiac resynchronization therapy (CRT‐D). This analysis of the prospectively conducted German Device Registry aims at comparing mortality rates, comorbidities, complication rates to results from RCT. Methods The German Device registry (DEVICE) prospectively collected data on ICD and CRT‐D first implantations from 50 German centres. Demographic data, details on cardiac disease, electrocardiogram (ECG), medication, and data about procedure, complications, and hospital stay were stored in electronic case report forms. One year after device implantation patients were contacted for follow‐up. Results DEVICE included n = 4384 first ICD/CRT‐D implantations (29.3% CRT‐D devices). We found a strong adherence to guidelines with over 90% of patients being on ß‐blocker and ACE‐inhibitor medication and adequate QRS width in the majority of CRT‐D patients. Patients receiving a CRT‐D were older (67.6 ± 11.0 years vs. 63.9 ± 13.4 years, p < .001) and had lower ejection fractions (mean 25% vs. 30%, p < .001) compared to ICD patients. Dilated cardiomyopathy was the predominant underlying heart disease in CRT‐D (53.3%), coronary artery disease in ICD patients (64.7%). Compared to RCT our DEVICE patients had more comorbidities (17.9% chronic kidney disease [CKD]) and higher 1‐year mortality rates (10.7% ICD group, 12.3% CRT group). In multivariate analysis, CKD patients had an almost 2‐fold higher risk of 1‐year mortality. Conclusion Despite relevant limitations of registry data, DEVICE highlights important differences between RCT and real‐world registry data and the impact of comorbidities on mortality of ICD and CRT‐D recipients.

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Comparison of current German and European practice in cardiac resynchronization therapy: lessons from the ESC/EHRA/HFA CRT Survey II

Cited by 4 publications

References 33 publications

Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II

Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II

Significance of myeloperoxidase plasma levels as a predictor for cardiac resynchronization therapy response

Selection and outcome of implantable cardioverter‐defibrillator patients with and without cardiac resynchronization therapy: Comparison of 4384 patients from the German Device Registry to randomized controlled trials

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