Contemporary use of devices in chronic heart failure in the Netherlands

Abstract

Aims Despite previous surveys regarding device implantation rates in heart failure (HF), insight into the real-world management with devices is scarce. Therefore, we investigated device implantation rates in HF with reduced left ventricular ejection fraction (LVEF) in 34 Dutch centres. Methods and results A cross-sectional outpatient registry was conducted in 6666 patients with LVEF < 50% and with information about device implantation available [74 (66-81) years of age; 64% male]. Patients were classified into conventional pacemakers (PM, n = 562), implantable cardioverter defibrillators (ICD, n = 1165), and cardiac resynchronization therapy with defibrillator function (CRT-D, n = 885) or pacemaker function only (CRT-P, n = 248), or no device (n = 3806). Centres were divided into ICD-implanting and CRT-implanting and referral centres. Overall, 17.5% had an ICD, 13.3% CRT-D, 3.7% CRT-P, and 8.4% PM. Of those with LVEF ≤ 30%, 42.5% had ICD or CRT-D therapy. A large variation in implantation rates existed between centres: 3-51% for ICD therapy, 0.3-44% for CRT-D therapy, 0-11% for CRT-P therapy, and 0-25% PM therapy. Implantation centres showed higher implantation rates of ICD, CRT-D, and CRT-P compared with referral centres [36% vs. 25% for defibrillators (ICD or CRT-D) and 17% vs. 9% for CRT devices (CRT-D or CRT-P), respectively, P < 0.001], independently of other factors. A large number of clinical factors were predictive for device usage. Among other, LVEF < 40% and male sex were independent positive predictors for ICD/CRT-D use [odds ratio (OR) = 3.33, P < 0.001; OR = 1.87, P = 0.019, respectively]. Older age was independently associated with less ICD/CRT-D (OR = 0.96 per year, P < 0.001) and more CRT-P/PM use (OR = 1.03 per year, P = 0.006). Conclusions In this large Dutch HF registry, less than half of the patients with reduced LVEF received an ICD or CRT, even if LVEF was ≤30%, and a large variation between centres existed. Patients from implantation centres had more often ICD or CRT. More uniformity regarding guideline-based use of device therapy in clinical practice is needed.

Utilization and Efficacy of Cardiac Resynchronization Therapy in Patients With Chronic Heart Failure ― A Report From the CHART-2 Study ―

“…In the present study, the CRT implantation rate was 47% of eligible patients, which is similar to implantation rates in other studies, namely 42.5% (Netherlands), 22 38.8% (US), 23 and 26.3% (US). 24 In addition, more than half the CRT implantations were performed between 2007 and 2011 based on the 2006 JCS guidelines, suggesting that the recent CRT implantation rate in Japan is not as high as we expected.…”

“…The mean follow-up period was 8.5 years, which was longer than that of the CHF cohort studies, whereas the mean age (68.3±0.3 years), percentage of men (69.6%), and percentage of patients with ischemic heart disease (56.3%) were similar to those in other CHF studies. 8 , 22 – 24 Thus, the present findings are important because they demonstrate the current status of CRT utilization and factors against the use of CRT.…”

“…Many studies indicate that CRT is still underused, with considerable heterogeneity in its implementation. 8 , 22 – 24 It also should be noted that elderly CHF patients are generally under-represented in clinical trials aiming to evaluate the efficacy of CRT. 25…”

Heart failure treatment in patients with cardiac implantable electronic devices: Opportunity for improvement

“…Baseline medical therapy in major registries and cohort studies of CRT and ICD (n 5 19) is presented in Figure 3. [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] CRT studies reported ACEI/ARB and betablocker baseline use in 78% (52%-100%) and 80% (70%-87%). Uptake was similar in ICD studies, 78% (59%-99%) and 85% (53%-97%), respectively.…”

Variation in regional implantation patterns of cardiac implantable electronic device in Switzerland

“…Most previous studies used data of CIED implantations up until 2012 only that may no longer be accurate. More recently published studies also used registry data (e.g., [16][17][18][19]) or included older data (e.g., [15,20,21]). Geographical variations in care are associated with a multitude of factors, including demographic, socioeconomic, and health system related factors (e.g., supply, access, reimbursement), and patient and physician preferences [22][23][24][25][26][27][28].…”