Camilla Normand1,2, Cecilia Linde3, Carina Blomström-Lundqvist4, Christoph Stellbrink5, Maurizio Gasparini6, Stefan D Anker7,8,9, Chris Plummer10, Nedim Umutay Sarigul11,12, Giorgi Papiashvili13, Svetoslav Iovev14, Kenneth Dickstein1,2. 1. Cardiology Division, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway. 2. Institute of Internal Medicine, University of Bergen, Bergen, Norway. 3. Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden. 4. Department of Medical Science and Cardiology, Uppsala University, Uppsala, Sweden. 5. Department of Cardiology, Klinikum Bielefeld, Bielefeld, Germany. 6. Department of Cardiology, Humanitas Research Hospital IRCCS, Rozzano, Italy. 7. Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany. 8. Berlin Institute of Health Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany. 9. German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany. 10. Department of Cardiology, Freeman Hospital, Freeman Rd, Newcastle upon Tyne, UK. 11. Department of Cardiology, Medicalpark Goztepe Hospital, Istanbul, Turkey. 12. Kardio Bremen, Bremen, Germany. 13. Arrhythmia Department, Helsicore - Israeli-Georgian Medical Research Clinic, Tbilisi, Georgia. 14. Cardiostimulation and Electrophysiology Sector at "St. Ekaterina" University Multi-profile Hospital for Active Treatment, Sofia, Bulgaria.
Abstract
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.