Kenneth Dickstein1,2, Camilla Normand1,2, Angelo Auricchio3, Nigussie Bogale1, John G Cleland4, Anselm K Gitt5,6,7, Christoph Stellbrink8, Stefan D Anker9,10, Gerasimos Filippatos11, Maurizio Gasparini12, Gerhard Hindricks13, Carina Blomström Lundqvist14, Piotr Ponikowski15, Frank Ruschitzka16, Giovanni Luca Botto17, Alan Bulava18,19,20, Gabor Duray21, Carsten Israel22, Christophe Leclercq23, Peter Margitfalvi24, Óscar Cano25, Chris Plummer26, Nedim Umutay Sarigul27,28, Maciej Sterlinski29, Cecilia Linde30. 1. Cardiology Division, Stavanger University Hospital, Stavanger, Norway. 2. Institute of Internal Medicine, University of Bergen, Bergen, Norway. 3. Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland. 4. Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Imperial College London, UK. 5. Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany. 6. Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. 7. University of Cyprus, School of Medicine, Cyprus. 8. Department of Cardiology, Klinikum Bielefeld, Germany. 9. Division of Cardiology and Metabolism; Department of Cardiology (CVK); Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany. 10. Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany. 11. National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece. 12. Humanitas Research Hospital IRCCS, Rozzano, Italy. 13. Department of Cardiac Surgery, HELIOS Heart Center Leipzig, Leipzig, Germany. 14. Department of Cardiology, Institution of Medical Science, Uppsala University, Uppsala, Sweden. 15. Department of Heart Diseases, Medical University Wroclaw, Wroclaw, Poland. 16. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland. 17. Sant'Anna Hospital, Como, Italy. 18. Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic. 19. Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic. 20. Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic. 21. Clinical Electrophysiology, Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary. 22. Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany. 23. Rennes University Hospital, University of Rennes, France. 24. The National Institute of Cardiovascular Diseases, Bratislava, Slovak Republic. 25. Unidad de Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain. 26. Department of Cardiology, Freeman Hospital, Freeman Rd, Newcastle upon Tyne, UK. 27. Department of Cardiology, Medicalpark Goztepe Hospital, Istanbul, Turkey. 28. Kardio Bremen, Bremen, Germany. 29. Heart Rhythm Department, Institute of Cardiology, Warsaw, Poland. 30. Heart and Vessels Theme, Karolinska University Hospital, Stockholm, and Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008-2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT. METHODS AND RESULTS: A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed. CONCLUSION: CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy.
BACKGROUND: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008-2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT. METHODS AND RESULTS: A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed. CONCLUSION: CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy.
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Authors: Matthias Lutz; David Messika-Zeitoun; Tanja K Rudolph; Eberhard Schulz; Jeetendra Thambyrajah; Guy Lloyd; Alexander Lauten; Norbert Frey; Jana Kurucova; Martin Thoenes; Cornelia Deutsch; Peter Bramlage; Richard Paul Steeds Journal: Open Heart Date: 2020-09