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Rates and reasons for device-based guideline eligibility in patients with heart failure

Kristin J Lyons1, Mohua Podder2, Justin A Ezekowitz3

  • 1Division of Cardiology, Department of Medicine; Mazankowski Alberta Heart Institute.

Heart Rhythm
|August 8, 2014
PubMed

Insights

Device therapy adherence for heart failure (HF) patients is higher than previously estimated. Accounting for patient preferences reveals improved rates for implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT).

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are guideline-recommended for heart failure (HF) patients.
  • Estimates of device eligibility and utilization are uncertain, partly due to how guideline nonadherence is assessed.

Purpose of the Study:

  • To determine guideline eligibility and device utilization rates for ICD and CRT.
  • To account for documented reasons for not receiving these devices.

Main Methods:

  • Retrospective chart review of 762 heart failure patients (2006-2011) at a Canadian tertiary Heart Function Clinic.
  • Data collected included factors for guideline eligibility and reasons for nonadherence.

Main Results:

  • 57% of patients were guideline-eligible for a device; 43% were never eligible.
  • Adherence rates for eligible patients were 59-68% (ICD) and 66-81% (CRT).
  • After excluding nonadherence reasons, adherence in "truly eligible" patients was higher (70-81% ICD, 71-88% CRT). Patient preference was a key reason for nonadherence.

Conclusions:

  • Device therapy utilization in HF patients is likely higher than prior registry estimates suggest.
  • Patient preferences significantly impact device use and should be considered in quality metrics.
  • Future quality-of-care metrics need detailed chart data and patient preference information.
Abstract

Keywords:
DisparitiesHeart failureImplantable devicesQuality of care

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