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Updated: Aug 23, 2025

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
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Defining the gap in heart failure treatment in patients with cardiac implantable electronic devices

Samaneh Salimian1, Nima Moghaddam1, Marc W Deyell1

  • 1Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|November 4, 2022
PubMed

Insights

Guideline-directed medical therapy (GDMT) uptake is low in heart failure patients with cardiac resynchronization therapy (CRT) or implantable cardioverter defibrillators (ICDs), despite high eligibility. Optimization gaps highlight the need for quality initiatives in device clinics.

Area of Science:

  • Cardiology
  • Medical Device Technology
  • Pharmacotherapy

Background:

  • Guideline-directed medical therapy (GDMT) use is not well-documented in patients with heart failure and reduced ejection fraction (HFrEF) who also have cardiac resynchronization therapy (CRT) and/or implantable cardioverter defibrillators (ICDs).
  • Understanding GDMT patterns in this complex patient group is crucial for optimizing treatment outcomes.

Purpose of the Study:

  • To assess the eligibility, uptake, dosage, contraindications, and barriers to contemporary medical therapy in HFrEF patients with CRT and/or ICDs.
  • To identify areas for improvement in GDMT prescription and titration within cardiac device clinics.

Main Methods:

  • A retrospective analysis was conducted on adult patients with HFrEF receiving CRT and/or ICDs.
  • Data were collected from two Canadian tertiary care device clinics between March 1 and May 31, 2021.
  • Included were 227 patients from 1005 device clinic consultations.

Main Results:

  • Eligibility for GDMT was high, with 99.6% for beta-blockers, 89.0% for mineralocorticoid receptor antagonists (MRA), 84.6% for angiotensin receptor-neprilysin inhibitors (ARNI), and 87.7% for sodium-glucose cotransporter-2 inhibitors (SGLT2I).
  • Uptake was high for beta-blockers (97.4%) but lower for MRA (63.0%), ARNI (46.7%), and SGLT2I (22.9%).
  • Target doses were achieved by less than half of patients for MRA (10.5%) and ARNI (47.7%), indicating significant titration gaps.

Conclusions:

  • Despite high eligibility, substantial gaps exist in the prescription and titration of GDMT for HFrEF patients with CRT/ICDs.
  • Quality assurance initiatives within cardiac device clinics are essential to enhance the care of these patients.
Abstract

Keywords:
CRTHeart failure reduced ejection fractionICDMedical therapyOptimization

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