Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of
Wilfried Mullens1,2, Angelo Auricchio3, Pieter Martens1,2
1Ziekenhuis Oost Limburg, Genk, Belgium.
Insights
Cardiac resynchronization therapy (CRT) improves outcomes for heart failure patients but is underused. This statement provides strategies for better CRT referral and post-procedure care to maximize treatment benefits.
Area of Science:
- Cardiology
- Heart Failure Management
- Cardiac Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) is highly effective for heart failure with reduced ejection fraction, improving quality of life and reducing mortality.
- Significant under-referral (up to two-thirds of eligible patients) and suboptimal post-implantation follow-up limit CRT's potential.
- This position statement addresses the optimized implementation of CRT.
Purpose of the Study:
- To provide theoretical and practical strategies for comprehensive CRT referral and post-procedural care.
- To address the under-utilization of CRT in eligible heart failure patients.
- To enhance the effectiveness of CRT through optimized implementation and follow-up.
Main Methods:
- A joint position statement developed by the Heart Failure Association (HFA), European Heart Rhythm Association (EHRA), and European Association of Cardiovascular Imaging (EACVI).
- Focus on four actionable domains: overcoming under-utilization, understanding pre-implant characteristics, reframing 'non-response' as disease modification, and implementing dedicated post-implant care pathways.
- Synthesis of current knowledge and clinical best practices for CRT implementation.
Main Results:
- Identified key barriers to CRT referral and outlined strategies to overcome them.
- Emphasized the importance of detailed pre-implant patient assessment.
- Proposed a shift from 'non-response' to 'disease modification' to better conceptualize CRT outcomes.
- Advocated for a structured, dedicated post-implant care pathway for CRT patients.
Conclusions:
- Optimizing CRT implementation requires addressing under-referral and improving post-procedural care.
- A comprehensive approach focusing on patient selection, understanding treatment effects, and dedicated follow-up is crucial for maximizing CRT benefits.
- This statement provides a framework for enhancing CRT delivery and patient outcomes in heart failure management.
Abstract:
Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post-implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains: (i) overcoming CRT under-utilization, (ii) better understanding of pre-implant characteristics, (iii) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (iv) implementing a dedicated post-implant CRT care pathway.
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