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The frequency and characterization of patients receiving cardiac
resynchronization therapy (CRT) are largely
unknown since the publication of pivotal
clinical trials and subsequent incorporation of
CRT into the American College of
Cardiology/American Heart Association guidelines
for heart failure.
Investigators analyzed 33 898 patients admitted from January
2005 through September 2007 to 228 hospitals
participating in the American Heart
Association’s Get With the Guidelines-Heart
Failure program. There were 4201 patients
(12.4%) discharged alive with CRT, including 811
new implants. Patients discharged with CRT were
older (median age, 75 versus 72 years) and had
lower median left ventricular ejection fraction
(30% versus 38%), more frequent ischemic
cardiomyopathy (58% versus 45%), more history of
atrial fibrillation (38% versus 27%), and higher
rates of b-blocker and aldosterone antagonist
use (P < 0.0001 for all) than those without CRT.
The study found that 4.8% of patients with left
ventricular ejection fraction £ 35% were
discharged with a new CRT implant, which varied
greatly by hospital. Ten percent of patients
discharged with a new CRT implant had a left
ventricular ejection fraction > 35%. Major
factors associated with lower rates of new CRT
placement were treatment in the northeast (odds
ratio, 0.40; 95% confidence interval, 0.30 to
0.53), black race (odds ratio, 0.45; 95%
confidence interval, 0.36 to 0.57), increasing
left ventricular ejection fraction per 10% (odds
ratio, 0.56; 95% confidence interval, 0.52 to
0.60), and increasing age per 10 years in those
> 70 years of age (odds ratio, 0.56; 95%
confidence interval, 0.48 to 0.65).
Although CRT is a recent evidence-based therapy for heart failure,
patterns of use differ significantly from
clinical trials and published guidelines.
Important variations also exist for CRT therapy
based on race, geographic region, comorbidities,
and age and need to be addressed through further
study and/or quality-of-care initiatives.
Circulation. 2008;118:926-933
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