Review of Eligibility for Cardiac Resynchronization Therapy

Hawkins, Nathaniel M.; Bennett, Matthew T.; Andrade, Jason G.; Virani, Sean; Krahn, Andrew D.; Ignaszewski, Andrew; Toma, Mustafa

doi:10.1016/j.amjcard.2015.04.026

Cited by 2 publications

(5 citation statements)

References 53 publications

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“…1,2 Among unselected patients hospitalized with HF, the proportion meeting these historic criteria was relatively consistent, ranging from 6% to 10%. [3][4][5][6][7] Subsequent landmark clinical trials demonstrated similar benefits from CRT in patients with milder symptoms (NYHA Class I/II). 8,9 Evidence is also accruing of efficacy in patients with atrial fibrillation (AF) and milder left ventricular systolic dysfunction (LVSD) meeting criteria for pacing due to bradycardia.…”

Section: Introductionmentioning

confidence: 99%

“…A minor concomitant contraction in eligibility has occurred, with guidelines now favouring LBBB morphology in patients with moderate QRS prolongation. As outlined in a recent systematic review, no study to date has examined the proportion of patients fulfilling these new criteria …”

Section: Introductionmentioning

confidence: 99%

“…As outlined in a recent systematic review, no study to date has examined the proportion of patients fulfilling these new criteria. 7…”

Section: Introductionmentioning

confidence: 99%

“…The American College of Cardiology/American Heart Association (ACC/AHA) 2008 and European Society of Cardiology (ESC) 2007 guidelines recommended CRT in patients with sinus rhythm, left ventricular ejection fraction (LVEF) ≤ 35%, QRS ≥ 120 ms, and New York Heart Association (NYHA) Functional Class III or ambulatory IV symptoms . Among unselected patients hospitalized with HF, the proportion meeting these historic criteria was relatively consistent, ranging from 6% to 10% . Subsequent landmark clinical trials demonstrated similar benefits from CRT in patients with milder symptoms (NYHA Class I/II) .…”

Section: Introductionmentioning

confidence: 99%

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Eligibility for cardiac resynchronization therapy in patients hospitalized with heart failure

et al. 2018

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AimsRecent guidelines recommend cardiac resynchronization therapy (CRT) in mildly symptomatic heart failure (HF) but favour left bundle branch block (LBBB) morphology in patients with moderate QRS prolongation (120–150 ms). We defined how many patients hospitalized with HF fulfil these criteria.Methods and resultsA single‐centre retrospective cohort study of 363 consecutive patients hospitalized with HF (438 admissions) was performed. Electronic imaging, electrocardiograms, and records were reviewed. Overall, 153 patients (42%) had left ventricular ejection fraction (LVEF) ≤ 35%, and 34% of patients had QRS prolongation. Eighty patients (22%) were potentially eligible with LVEF ≤ 35% and QRS ≥ 120 ms or existing CRT. The majority (68 of 80) had a Class I or IIa recommendation according to international guidelines (LBBB or non‐LBBB QRS ≥ 150 ms or right ventricular pacing). Only a minority (12 of 80) had moderate QRS prolongation of non‐LBBB morphology. One‐quarter (n = 22) of patients fulfilling criteria were ineligible for reasons including dementia, co‐morbidities, or palliative care. A further eight patients required optimization of medical therapy. CRT was therefore immediately indicated in 50 patients. Of these, 29 were implanted or had existing CRT systems. Twenty‐one of the 80 patients eligible for CRT were not identified or treated (6% of the total hospitalized cohort).ConclusionsTwenty‐two per cent of elderly real‐life patients hospitalized with HF fulfil LVEF and QRS criteria for CRT, most having a Class I or IIa indication. However, a large proportion is ineligible owing to co‐morbidities or requires medical optimization. Although uptake of CRT was reasonable, there remain opportunities for improvement.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…As outlined in a recent systematic review, no study to date has examined the proportion of patients fulfilling these new criteria. 7…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Eligibility for cardiac resynchronization therapy in patients hospitalized with heart failure

et al. 2018

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“…CRT improves cardiac function, symptoms, quality of life and exercise capacity and reduces HF hospitalizations, ventricular arrhythmias, and mortality and is cost-effective (6)(7)(8)(9)(10). Although up to 14% of patients with HF meet the eligibility criteria for CRT, it appears generally underused, with great heterogeneity in its implementation in North America and Europe and elsewhere (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%