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Which Factors Influence the Immensely Fluctuating CRT Implantation Rates in Europe? A Mixed Methods Approach Using
Christoph Edlinger1,2,3, Marwin Bannehr1,2, Christian Georgi1,2
1Department of Cardiology, Heart Center Brandenburg, 16321 Berlin, Germany.
Insights
Economic factors, not guideline adherence, influence cardiac resynchronisation therapy (CRT) implantation rates in German-speaking countries. Healthcare financing systems and device costs are key drivers, despite clear European Society of Cardiology (ESC) guidelines.
Area of Science:
- Cardiology
- Health Economics
- Healthcare Management
Background:
- Cardiac resynchronisation therapy (CRT) is a vital treatment for heart failure.
- Significant variations in CRT implantation rates exist across Europe, particularly in German-speaking regions.
- European Society of Cardiology (ESC) guidelines provide clear indications for CRT.
Purpose of the Study:
- To investigate the reasons behind disparities in CRT implantation rates in Germany, Austria, and Switzerland.
- To identify factors influencing the adoption of CRT across different healthcare systems.
- To explore the role of economic and systemic factors in CRT utilization.
Main Methods:
- Qualitative research approach utilizing semi-standardized interviews.
- Conducted interviews with 11 CRT therapy experts from Germany, Austria, and Switzerland.
- Analysis of interview data using Mayring's qualitative content analysis.
Main Results:
- Healthcare financing systems and device purchasing costs were identified as primary influencing factors.
- Cost pressure appears to play a secondary role in German-speaking countries.
- Lack of ESC guideline implementation, insufficient training, and inadequate medical infrastructure were ruled out as reasons.
Conclusions:
- Economic factors significantly impact fluctuating CRT implantation figures in German-speaking countries.
- Adherence to ESC guidelines does not appear to be a major driver of these variations.
- Expert consensus highlights systemic and financial aspects over clinical guideline adherence.
Abstract:
(1) Background: Cardiac resynchronisation therapy (CRT) is nowadays an indispensable treatment option for heart failure. Although the indication is subject to clear cross-national guidelines by the European Society of Cardiology (ESC), there is immense variation in the number of implantations per 100,000 inhabitants in Europe, especially in German-speaking countries (Germany, Austria and Switzerland). The aim of the present study was to identify possible factors for these differences using a qualitative research approach. (2) Methods: Semi-standardized interviews were conducted with 11 experts in the field of CRT therapy (3 experts from Germany, 4 from Austria and 4 from Switzerland) using a pre-prepared interview template and analysed according to Mayring's qualitative content analysis. (3) Results: The main factors identified were the costs of purchasing the devices and the financing systems of the respective healthcare systems, although cost pressure still seems to play a subordinate role in the German-speaking countries. Moreover, "lack of implementation of ESC guidelines", "insufficient training" and "lack of medical infrastructure" could be excluded as potential reasons. (4) Conclusions: Economic factors, but not a lack of adherence to ESC guidelines, seem to have a major influence on the fluctuating implantation figures in German-speaking countries, according to the unanimous assessment of renowned experts.
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