Fifteen-Year Differences in Indications for Cardiac Resynchronization Therapy in International Guidelines—Insights from the Heart Failure Registries of the European Society of Cardiology

Abstract

Cardiac resynchronization therapy (CRT) applied to selected patients with heart failure (HF) improves their prognosis. In recent years, eligibility criteria for CRT have regularly changed. This study aimed to investigate the changes in eligibility of real-life HF patients for CRT over the past fifteen years. We reviewed European and North American guidelines from this period and applied them to HF patients from the ESC-HF Pilot and ESC-Long-Term Registries. Taking into consideration the criteria assessed in this study (including all classes of recommendations i.e., class I, IIa and IIb, as well as patients with AF and SR), the 2013 (ESC) guidelines would have qualified the most patients for CRT (266, 18.3%), while the 2015 (ESC) guidelines would have qualified the least (115, 7.9%; p-value for differences between all analyzed papers <0.0001). There were only 26 patients (1.8%) who would be eligible for CRT using the class I recommendations across all of the guidelines. These results demonstrate the variability in recommendations for CRT over the years. Moreover, this data indicates underuse of this form of pacing in HF and highlights the need for more studies in order to improve the outcomes of HF patients and further personalize their management.

Prognosis of CRT-treated and CRT-untreated unselected population with LBBB in Stockholm County

“…The magnitude of the problem varies based on eligibility criteria and population selection. 13 , 14 Lund et al 15 reported that CRT underutilization varies, depending on different consistency analyses, from 69 to 79% based on class I and IIa indications from 2013 EHRA. Linde et al 16 estimated that two-thirds of eligible HFrEF patients were not receiving CRT.…”

Special Issue: Latest Advances in Delivery and Outcomes of Cardiac Resynchronization Therapy and Conduction System Pacing

“…If they respond to inotrope therapy, CRT could possibly delay or replace advanced heart failure therapies such as left ventricular assist devices or transplantation. Guidelines have changed significantly in the last 15 years [15]. Diminished renal function is a comorbidity that is associated with poor outcome in heart failure and might hamper the benefit of CRT [16].…”