Author + information
- Received February 22, 2017
- Accepted February 23, 2017
- Published online March 17, 2017.
- Kristin J. Lyons, MDCM∗,
- Justin A. Ezekowitz, MBBCh MSc†,
- Li Liang, PhD‡,
- Paul A. Heidenrich, MD MSe,
- Clyde W. Yancy, MD§,
- Adam D. Devore, MD MHS‡,
- Adrian F. Hernandez, MD‡ and
- Gregg C. Fonarow, MD∗∗∗ ()
- ∗Division of Cardiology, University of Calgary, Calgary, Canada
- †Canadian VIGOUR Centre and Division of Cardiology, University of Alberta, Edmonton, Canada
- ‡Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
- §Veteran Affairs Palo Alto Health Care System, Palo Alto, California
- eDivision of Cardiology, Northwestern University, Chicago, Illinois
- ∗∗Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles Medical Center, Los Angeles, California
- ↵∗Address for Correspondance:
Gregg C. Fonarow, MD, Ahmanson–UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Avenue, Room A2-237 CHS, Los Angeles, CA 90095-1679, Phone: (310) 206-9112 Fax: (310) 206-9111.
Background The 2013 heart failure (HF) guidelines of the American College of Cardiology Foundation and American Heart Association (ACCF-AHA) narrow the recommendations for cardiac resynchronization therapy (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-HF between 2012 and 2015, we evaluated the proportion of hospitalized patients with HF eligible for CRT based on Historic and Current guideline recommendations. We 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 or patient-related reason for not prescribing CRT were excluded.
Results Overall, 49.1% (n=12,336) of HF patients with LVEF ≤ 35% and without a documented contraindication were eligible for CRT based on Historic guidelines and 33.1% (n=8,299) of patients were eligible for CRT based on Current guidelines, a 16.1% absolute reduction in eligibility, P<0.0001. Patients eligible for CRT based on Current guidelines were more likely to have a CRT-D or CRT-P placed or prescribed at discharge (57.8% versus 54.9%, P<0.0001) compared to patients eligible for CRT based on Historic guidelines.
Conclusions In this HF population with LVEF ≤ 35% and without a documented contraindication for CRT, the Current ACCF-AHA HF guidelines reduce the proportion of patients eligible for CRT by approximately 15%.
Funding Sources: Get WithThe Guidelines-Heart Failure (GWTG-HF) program is provided by the American Heart Association. GWTG-HF 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.
Disclosures: Kristin J Lyons None; Justin A Ezekowitz None; Li Liang None; Paul A Heidenrich None; Clyde W Yancy None; Adam D Devore Research support from the Amercian Heart Assoication, Amgen, and Novartis. Served on an advisory board with Novartis; Adrian F Hernandez Research support from Janssen, Novartis, Portola, Bristol-Myers Squib. Consultant for Bristol-Myers Squibb, Gilead, Boston Scientific, Janssen, Novartis; Gregg C Fonarow Research support from National Institutes of Heath. Consultant for Amgen, Janssen, Medtronic, Novartis, and St Jude Medical.
- Received February 22, 2017.
- Accepted February 23, 2017.