Author + information
- Received February 22, 2017
- Accepted February 23, 2017
- Published online April 24, 2017.
- Kristin J. Lyons, MDCMa,
- Justin A. Ezekowitz, MBBCh, MScb,
- Li Liang, PhDc,
- Paul A. Heidenreich, MD, MSd,
- Clyde W. Yancy, MD, MSce,
- Adam D. DeVore, MD, MHSc,
- Adrian F. Hernandez, MDc and
- Gregg C. Fonarow, MDf,∗ ()
- aDivision of Cardiology, University of Calgary, Calgary, Alberta, Canada
- bCanadian VIGOUR Centre and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
- cDuke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
- dVeterans Affairs Palo Alto Health Care System, Palo Alto, California
- eDivision of Cardiology, Northwestern University, Chicago, Illinois
- fAhmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Gregg C. Fonarow, Ahmanson–UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Avenue, Room A2-237 CHS, Los Angeles, California 90095.
Objectives This study sought to ascertain the impact of heart failure (HF) guideline change on the number of patients eligible to undergo cardiac resynchronization therapy (CRT).
Background The 2013 HF guideline of the American College of Cardiology Foundation and American Heart Association (ACCF/AHA) narrowed the recommendations for CRT. The impact of this guideline change on the number of eligible patients for CRT has not been described.
Methods Using data from Get With The Guidelines–Heart Failure between 2012 and 2015, this study evaluated the proportion of hospitalized patients with HF who were eligible for CRT on the basis of historical and current guideline recommendations. The authors identified 25,102 hospitalizations for HF that included patients with a left ventricular ejection fraction (LVEF) ≤35% from 283 hospitals. Patients with a medical, system-related, or patient-related reason for not undergoing CRT were excluded.
Results Overall, 49.1% (n = 12,336) of patients with HF, an LVEF ≤35%, and no documented contraindication were eligible for CRT on the basis of historical guidelines, and 33.1% (n = 8,299) of patients were eligible for CRT on the basis of current guidelines, a 16.1% absolute reduction in eligibility (p < 0.0001). Patients eligible for CRT on the basis of current guidelines were more likely to have CRT with an implantable cardioverter-defibrillator or CRT with pacing only placed or prescribed at discharge (57.8% vs. 54.9%; p < 0.0001) compared with patients eligible for CRT on the basis of historical guidelines.
Conclusions In this population of patients with HF, an LVEF ≤35%, and no documented contraindication for CRT, the current ACCF/AHA HF guidelines reduce the proportion of patients eligible for CRT by approximately 15%.
The Get With The Guidelines-Heart Failure program is provided by the American Heart Association; it has been funded in the past through support from Amgen, Medtronic, GlaxoSmithKline, Ortho-McNeil, and the American Heart Association Pharmaceutical Roundtable. These sponsors had no role in the study design, data analysis, or manuscript preparation and revision. Dr. DeVore has received research support from the American Heart Association, Amgen, and Novartis; and has served on an advisory board for Novartis. Dr. Hernandez has received research support from Janssen, Novartis, Portola, and Bristol-Myers Squibb; and has been a consultant for Bristol-Myers Squibb, Gilead, Boston Scientific, Janssen, and Novartis. Dr. Fonarow has received research support from the National Institutes of Health; and has been a consultant for Amgen, Janssen, Medtronic, Novartis, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 22, 2017.
- Accepted February 23, 2017.
- 2017 American College of Cardiology Foundation