Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care

Abstract

Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all‐cause mortality. Nevertheless, up to two‐thirds of eligible patients are not referred for CRT. Furthermore, post‐implantation follow‐up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post‐procedural care by focusing on four actionable domains: (i) overcoming CRT under‐utilization, (ii) better understanding of pre‐implant characteristics, (iii) abandoning the term ‘non‐response’ and replacing this by the concept of disease modification, and (iv) implementing a dedicated post‐implant CRT care pathway.

What Are the Expectations for Cardiac Resynchronization Therapy? A Validation of Two Response Definitions

“…Mullens et al published a position statement on recommendations for managing patients who have undergone CRT, and patients who are future candidates for CRT [ 24 ]. They addressed the underutilization of CRT, the definition of CRT response, and the optimization of post-implant CRT care.…”

Echocardiographic view and feature selection for the estimation of the response to CRT

“…To our knowledge, this is the first quantitative analysis of the contribution of multi-view echocardiographic features to the estimation of CRT response. This could be a step forward for CRT that remains under-used, partly because of the problem of lack of response of certain patients and the imperfect selection criteria that are recommended, up to now, by current guidelines [ 3 ].…”

“…20 to 30% of heart failure patients with reduced ejection fraction show a left bundle branch block (LBBB). These patients might benefit from a CRT implantation, with a reverse remodeling of the left ventricle (LV), an improvement in systolic function, a better control of symptoms and, finally, an improved quality of life and life expectancy [ 3 ]. Despite its well-established clinical benefits and cost-effectiveness, it remains a widely underutilized treatment option.…”

Gain in real-world cardiac resynchronization therapy efficacy with SyncAV dynamic optimization: Heart failure hospitalizations and costs

“…The study was limited to patients on Medicare fee-for-service insurance and excluded enrollees in private insurance or Medicare Advantage plans. Structural remodeling changes were unavailable but our metric of HFH is used most often in practice 2 , has driven the primary endpoint of pivotal CRT trials 1 , and is advocated to be a robust marker of clinical outcomes 4,28 .…”