Croatian National Data and Comparison with European Practice: Data from the Cardiac Resynchronization Therapy Survey II Multicenter Registry

Abstract

Aims The Cardiac Resynchronization Therapy (CRT) Survey II was conducted between October 2015 and December 2016 and included data from 11088 CRT implantations from 42 countries. The survey's aim was to report on current European CRT practice. The aim of this study was to compare the Croatian national CRT practice with the European data. Methods Five centres from Croatia recruited consecutive patients, in a 15-month period, who underwent CRT implantation, primary or an upgrade. Data were collected prospectively by using online database. Results A total of 115 patients were included in Croatia, which is 33.2% of all CRT implants in Croatia during the study period (total n=346). Median age of the study population was 67 (61–73) years, and 21.2% were women. Primary heart failure (HF) aetiology was nonischemic in 61.1% of patients, and HF with wide QRS was the most common indication for the implantation (73.5%). 80% of patients had complete left bundle branch block, and over two-third had QRS ≥150 ms. Device-related adverse events were recorded in 4.3% of patients. When compared with European countries, Croatian patients were significantly younger (67 vs. 70 years, p=0.012), had similar rate of comorbidities with the exception of higher prevalence of hypertension. Croatian patients significantly more often received CRT-pacemaker when compared with European population (58.3 vs. 29.9%, OR 3.27, 95%CI 2.25–4.74, p < 0.001). Conclusion Our data indicate strict selection of patients among HF population and adherence to guidelines with exception of higher proportion of CRT-pacemaker implantation. This is likely to be influenced by healthcare organization and reimbursement issues in Croatia.

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

“…Such large emphasis on QRS morphology and duration is believed to be due to health care budget restrictions in Croatia. 52 Bulgaria, Croatia and Switzerland had lower percentage CRT-D than the total cohort. 52,55,57 The Croatian and Bulgarian implanters attribute this lower percentage to budgetary restriction; in Bulgaria CRT-D is not fully reimbursed and patients are not always able to afford co-payments for these devices.…”

“…52 Bulgaria, Croatia and Switzerland had lower percentage CRT-D than the total cohort. 52,55,57 The Croatian and Bulgarian implanters attribute this lower percentage to budgetary restriction; in Bulgaria CRT-D is not fully reimbursed and patients are not always able to afford co-payments for these devices. Switzerland, on the other hand, has a reimbursement system that allows for easy access to available technology.…”

“…Of the countries participating in CRT Survey II eleven have published national publications benchmarking their countries data against the total cohort. [48][49][50][51][52][53][54][55][56][57][58] Overall, patient selection and guideline adherence was similar in the 42 participating countries. However, these publications have highlighted some interesting differences.…”

“…Croatia, Bulgaria, Poland, Switzerland and Germany all reported higher co-morbidities in their CRT population compared with the total cohort. 52,[54][55][56][57] Possible explanations for the higher rate of comorbidities in patients in Germany is speculated to be a reluctance in other European countries to implant CRT in 'sicker' patients. In Bulgaria patients also appear to be referred later for a CRT device as more patients were in NYHA Class III or IV.…”

Management of Patients with Cardiac Implantable Electronic Devices Undergoing Magnetic Resonance Imaging – Proposal for Unified Hospital Protocol: Croatian Working Group on Arrhythmias and Cardiac Pacing

“…Epidemiological data show that almost 75% of patients with CIED will have an indication for MRI during their lifetime ( 1 ). With the increasing number of patients being implanted with CIEDs ( 2 , 3 ), in some of whom MRI may not be adequately replaced by other diagnostic imaging, there is the need for a standardized protocol for MRI imaging in these patients. Today, numerous studies have shown that it is possible and safe to use MRI in the large majority of CIED patients even up to 3T ( 4 - 7 ).…”