Rates and reasons for device-based guideline eligibility in patients with heart failure

Lyons, Kristin; Podder, Mohua

doi:10.1016/j.hrthm.2014.08.004

Cited by 12 publications

(21 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several previous publications from registries have demonstrated under-utilization of CRT. [42][43][44] However, none of these studies assessed the adherence to ESC Guideline recommendations for CRT in patients implanted with a CRT device. A small retrospective study from the Netherlands in 2012 showed that 92% (45/49) of patients with a class I indication for a CRT underwent implantation (using the 2010 ESC focused update of ESC Guideline for Device Therapy in Heart Failure).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Besides regional differences, significant inequalities have been shown for race and sex: particularly women and minority patients received less often ICDs despite eligibility according to international HF guidelines (9). Device therapy rates are lower in elderly patients despite the fact that guidelines recommend device therapy regardless of age (10–12).…”

Section: Introductionmentioning

confidence: 99%

Contemporary use of devices in chronic heart failure in the Netherlands

et al. 2020

View full text Add to dashboard Cite

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.

show abstract

“…However, even among cardiology specialists, an estimated one‐third were unaware of recommendations . Physician knowledge is an important factor influencing decision for ICD referral; however, little is known about other reasons for nonreferral and whether barriers differ among referring physicians.…”

Section: Introductionmentioning

confidence: 99%

Assessing physician knowledge regarding indications for a primary prevention implantable defibrillator and potential barriers for referral

Bernier

Raj

Tran

et al. 2017

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

Rates and reasons for device-based guideline eligibility in patients with heart failure

Cited by 12 publications

References 28 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

Contemporary use of devices in chronic heart failure in the Netherlands

Assessing physician knowledge regarding indications for a primary prevention implantable defibrillator and potential barriers for referral

Contact Info

Product

Resources

About