How many patients with heart failure are eligible for cardiac resynchronization? Insights from two prospective
Finlay A McAlister1, Jack V Tu, Alice Newman
1The Division of General Internal Medicine, 2E3.24 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada. finlay.mcalister@ualberta.ca
Insights
Few heart failure patients meet eligibility criteria for cardiac resynchronization therapy (CRT). This study found low proportions of eligible patients in both hospital discharge and specialty clinic cohorts.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Cardiac resynchronization therapy (CRT) is an established treatment for heart failure.
- Patient selection for CRT is crucial for optimal outcomes.
- Previous studies have focused on CRT efficacy, but eligibility in real-world settings requires further investigation.
Purpose of the Study:
- To determine the proportion of heart failure patients eligible for cardiac resynchronization therapy (CRT).
- To assess CRT eligibility across different patient cohorts and clinical settings.
Main Methods:
- Applied established CRT trial eligibility criteria (LVEF ≤ 0.35, QRS ≥ 120 ms, sinus rhythm, NYHA class III-IV) to two prospective heart failure cohorts.
- Analyzed data from a hospital discharge cohort (n=9096) and a specialty clinic cohort (n=309).
- Evaluated impact of requiring persistent symptoms despite spironolactone on eligibility.
Main Results:
- In the hospital discharge cohort, only 1% of all heart failure patients (3% with specific cardiomyopathies) met CRT trial criteria.
- In the specialty clinic cohort, 17% of all heart failure patients (21% with specific cardiomyopathies) met criteria.
- Requiring persistent symptoms despite spironolactone reduced eligibility to 1% and 18% in the respective cohorts.
Conclusions:
- A small proportion of heart failure patients meet the stringent trial eligibility criteria for CRT.
- Real-world CRT eligibility may differ significantly from trial populations.
- Current eligibility criteria may limit access to CRT for many heart failure patients.
Aims:
To determine what proportion of patients with heart failure are eligible for cardiac resynchronization therapy (CRT).
Methods And Results:
Eligibility criteria from the trials establishing the efficacy of CRT were applied to two prospective cohorts: the first enrolled patients with newly diagnosed heart failure discharged from 103 hospitals between April 1999 and March 2001 ('the hospital discharge cohort'); the second enrolled patients seen in a specialized clinic between August 2003 and January 2004 ('the specialty clinic cohort'). In the hospital discharge cohort, 73 patients (3% of the 2640 patients with ischaemic or dilated cardiomyopathy and 1% of all 9096 patients with heart failure discharged alive) met trial eligibility criteria: LVEF< or =0.35, QRS > or =120 ms, sinus rhythm, and NYHA class III or IV symptoms despite the treatment with ACE-inhibitor/angiotensin receptor blocker and beta-blocker. In the specialty clinic cohort, 54 patients (21% of the 263 patients with ischaemic or dilated cardiomyopathy and 17% of all 309 patients with heart failure) met these criteria. If persistent symptoms despite taking spironolactone were required for CRT eligibility, then the proportions qualifying dropped to 1% in the hospital discharge cohort and 18% in the specialty clinic cohort.
Conclusion:
Few heart failure patients meet trial eligibility criteria for CRT.
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