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Successful treatment of heart failure with devices requires collaboration

Karl Swedberg1, John Cleland, Martin R Cowie

  • 1Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. karl.swedberg@gu.se

European Journal of Heart Failure
|November 14, 2008
PubMed

Insights

Implanted cardiac resynchronisation therapy (CRT) and implantable cardioverter defibrillators (ICD) improve outcomes in heart failure patients. Underuse persists due to guideline adherence issues, necessitating improved collaboration and education for better patient care.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac resynchronisation therapy (CRT) and implantable cardioverter defibrillators (ICDs) are proven to enhance survival and reduce morbidity in select chronic heart failure (CHF) patients.
  • Evidence for device therapy in specific subgroups, like NYHA Class I or IV heart failure with reduced ejection fraction, or modest QRS prolongation, remains limited.
  • Despite established benefits, a significant gap exists between eligible patients and those receiving these life-saving device therapies.

Purpose of the Study:

  • To highlight the underutilization of CRT and ICDs in chronic heart failure (CHF) management.
  • To identify barriers to device therapy adoption, including healthcare professional adherence to guidelines.
  • To advocate for improved collaboration among specialists and structured approaches to optimize device therapy delivery.

Main Methods:

  • Review of current evidence on CRT and ICD efficacy in chronic heart failure (CHF).
  • Analysis of reasons for underuse of device therapies in eligible patient populations.
  • Discussion of strategies to improve guideline adherence and patient access to device therapy.

Main Results:

  • CRT and ICDs offer survival and morbidity benefits for specific CHF patient groups.
  • Limited evidence exists for device therapy in certain patient subgroups, contributing to hesitancy.
  • A minority of eligible CHF patients currently receive recommended device therapies, indicating underuse.

Conclusions:

  • Underuse of CRT and ICDs in CHF is a significant issue, partly due to poor guideline adherence.
  • Enhanced collaboration between heart failure specialists, electrophysiologists, and primary care physicians is crucial.
  • A structured, collaborative approach is needed to improve care, reduce mortality and morbidity, and increase cost-effectiveness.

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