Need and evolution of need for device therapy in a community heart failure population

Abstract

Background: New guidelines for implantable cardiac defibrillators (ICD) and cardiac resynchronisation therapy (CRT) have expanded the potential use for device therapy. The implications of this on a community heart failure (HF) population are unknown. Aim: To assess the need for device therapy and the change in need over time. Methods: We reviewed device need in a community HF population using ESC guidelines. Change in need was assessed by comparing data between an annual visit called TP2 and an earlier visit called TP1. Patients' need and change in need between TP1 and TP2 was determined. Results: 210 patients were included; mean age 70 ± 12 years, 67% male and 54% ischaemic. At TP1, 34% of patients were suitable for ICD and 3% for CRT. At TP2, 22% and 1% were suitable respectively. Of those suitable for ICD at TP1, 19% lost the need at TP2; in addition 9% of patients unsuitable for ICD at TP1 had acquired the need by TP2. Fifty five percent of patients were unsuitable for ICD at either time point, and 16% were suitable at both time points. CRT need was negligible but also noted to change. Conclusion: ICD need is substantial in a community HF population, but CRT need is limited. ICD need changes significantly. Identifying those likely to change their need may optimise ICD use.

Review of Eligibility for Cardiac Resynchronization Therapy

“…Eligibility was lowest (1% to 7%) in studies with higher QRSd cutoffs 22,25,27 or fewer patients with severe LVSD or symptoms. 22,26 The higher estimates of eligibility (14% to 33%) derived from cohorts with more severe LVSD or higher NYHA class. 13,14,17,20,23,24 These were typically heart function or cardiomyopathy clinics at academic centers.…”

“…23,28e30,32 Of particular interest, 2 studies reported the distribution of QRS morphology according to the ejection fraction. 26,32 In an Irish clinic and a Dutch hospitalized cohort, 17% and 20% of the general HF populations had LBBB. This increased to 30% and 31%, respectively, in the subgroups with LVEFs 35%.…”

Clinical and psychological impact of prophylactic implantable cardioverter-defibrillators in a community heart failure population

“…We have previously shown in our heart failure population that 44% of patients with systolic heart failure meet the criteria for ICD insertion for primary prevention, however only 23% of those patients have the device 372 inserted to date [19]. Although a larger number of patients met the criteria for ICD insertion for primary prophylaxis, in reality, a selection bias may occur which takes into consideration the limited economical and medical resources as well as the patients co-morbidities and various concerns about ICD implantation.…”