Cardiac resynchronization therapy in the ageing population – With or without an implantable defibrillator?

Doering, Michael; Ebert, Micaela; Dagres, Nikolaos; Müssigbrodt, Andreas; Bode, Kerstin; Knopp, Helge; Kühl, Michael; Hindricks, Gerhard; Richter, Sergio

doi:10.1016/j.ijcard.2018.03.087

Cited by 24 publications

(28 citation statements)

References 27 publications

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“…97 In a retrospective analysis of CRT in 177 patients >75 years of age there was no difference in mortality between he CRT-P and CRT-D groups in this elderly population. 98 A similar result was seen with a retrospective analysis of patients aged ≥75 years in Canada. Mortality data were compared for 128 patients with a CRT-D vs. 42 with a CRT-P and, again, there was no significant difference in mortality or cardiac hospitalization between these two groups.…”

supporting

confidence: 77%

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

et al. 2020

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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.

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supporting

confidence: 77%

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

et al. 2020

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“…It had by far the strongest influence on the model results. There is an ongoing debate about the additional value of the defibrillator in science [48,49]. For instance, a reduction of sudden cardiac death as a result of improved medical therapy such as sacubitril/valsartan or improved utilisation of beta blockers, ACE inhibitors and mineralocortocioid antagonists [50], would be expected to decrease the survival benefit of CRT-D and thereby increase the ICER.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Resynchronisation Therapy in Patients with Moderate to Severe Heart Failure in Germany: A Cost-Utility Analysis of the Additional Defibrillator

Hadwiger

Frielitz

Eisemann

et al. 2020

Appl Health Econ Health Policy

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Background Cardiac resynchronisation therapy (CRT) is a well-established form of treatment for patients with heart failure and cardiac dyssynchrony. There are two different types of CRT devices: the biventricular pacemaker (CRT-P) and the biventricular defibrillator (CRT-D). The latter is more complex but also more expensive. For the majority of patients who are eligible for CRT, both devices are appropriate according to current guidelines. The purpose of this study was to conduct a cost-utility analysis for CRT-D compared to CRT-P from a German payer's perspective. Methods A cohort Markov-model was developed to assess average costs and quality-adjusted life-years (QALY) for CRT-D and CRT-P. The model consisted of six stages: one for the device implementation, one for the absorbing state death, and two stages ("Stable" and "Hospital") for either a CRT device or medical therapy. The time horizon was 20 years. Deterministic and probabilistic sensitivity analyses and scenario analyses were conducted. Results The incremental cost-effectiveness ratio (ICER) of CRT-D compared with CRT-P was €24,659 per additional QALY gained. In deterministic sensitivity analysis, the survival advantage of CRT-D to CRT-P was the most influential input parameter. In the probabilistic sensitivity analysis 96% of the simulated cases were more effective but also more costly. Conclusions Therapy with CRT-D compared to CRT-P resulted in an additional gain of QALYs, but was more expensive. In addition, the ICER was subject to uncertainty, especially due to the uncertainty in the survival benefit. A randomised controlled trial and subgroup analyses would be desirable to further inform decision making.

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“…CRT-P patients in this cohort tended to be older and mainly had a non-ischaemic aetiology. [31] In addition, while there are emerging data suggesting that addition of an ICD in elderly patients (>75 years) undergoing CRT implant does not impact on survival,[32] it is worth remembering CRT-P alone is an excellent treatment option, as demonstrated in the CArdiac REsynchronisation in Heart Failure (CARE-HF) study. [33] The final decision on CRT-D versus CRT-P should not only be guided by heart failure aetiology but, more importantly, our patients' expectations and desires.…”

Section: Cardiac Resynchronisation Therapymentioning

confidence: 99%

Implantable Cardiac Electronic Devices in the Elderly Population

Lim

Prabhu

Schilling

2019

Arrhythm Electrophysiol Rev

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The use of cardiac implantable electronic devices in the management of patients with heart rhythm conditions is well established. As the population ages, the use of cardiac implantable electronic devices in the elderly is likely to increase. This review provides a summary of the indications, implantation considerations and pragmatic advice on how to approach the use of these devices in this group of patients.

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Cardiac resynchronization therapy in the ageing population – With or without an implantable defibrillator?

Cited by 24 publications

References 27 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

Cardiac Resynchronisation Therapy in Patients with Moderate to Severe Heart Failure in Germany: A Cost-Utility Analysis of the Additional Defibrillator

Implantable Cardiac Electronic Devices in the Elderly Population

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