Related Experiment Video
Updated: Jun 29, 2025
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Guideline-directed device therapies in heart failure: A clinical practice-based analysis using electronic health
Anne B Curtis1, Christopher Manrodt2, Luke D Jacobsen2
1Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America.
Insights
Guideline-directed device therapies (GDDT) like ICDs and CRT-Ds are underutilized in eligible heart failure patients. Many patients received other indicated treatments, but not these life-saving devices.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Guideline-directed device therapies (GDDT) improve outcomes in heart failure with reduced ejection fraction (HFrEF).
- Utilization rates of GDDT in HFrEF post-2012 guidelines are not well-studied.
Purpose of the Study:
- To characterize the utilization of GDDT in newly indicated HFrEF patients between 2012 and 2019.
- To analyze trends in device therapy adoption using electronic health record (EHR) data.
Main Methods:
- Employed computable phenotyping algorithms (GLIDE-HF) on de-identified EHR data.
- Included HFrEF patients with new Class 1 or 2a indications for ICD or CRT-D from 2012-2019.
Main Results:
- 137,476 HFrEF patients were newly indicated for ICD or CRT-D.
- GDDT use was 41.0% for CRT-D and 14.7% for ICD indications.
- High rates of echocardiography (95.7%) and guideline-indicated medications (92.1%) were observed.
Conclusions:
- A significant proportion of eligible HFrEF patients did not receive ICDs or CRT-Ds.
- Other guideline-indicated cardiovascular interventions and treatments were frequently administered.
Background:
Guideline-directed device therapies (GDDT) improve outcomes for eligible patients with heart failure (HF) with reduced ejection fraction (HFrEF). Utilization rates of device therapies in HFrEF after the 2012 ACCF/AHA/HRS Focused Update for Device-based Therapies of Cardiac Rhythm Abnormalities have not been well studied.
Objective:
Characterize the use of GDDT in newly indicated HFrEF patients from 2012 to 2019 using aggregated electronic health record (EHR) data.
Methods:
Computable phenotyping algorithms for implantable cardioverter defibrillator/cardiac resynchronization therapy-defibrillator (ICD/CRT-D) indications from the GuideLine Indications Detected in EHR for Heart Failure program (GLIDE-HF) used diagnoses, procedures, measures, prescriptions, and the output of natural language processed provider notes from de-identified Optum® EHR data. Patients had a diagnosis of HF, dilated cardiomyopathy, or prior infarct, and were included if they had HFrEF with >1 year of records prior to a new Class 1 or Class 2a indication for an ICD or cardiac resynchronization therapy with defibrillator (CRT-D) from 2012 to 2019.
Results:
Records showed 137,476 HFrEF patients were newly indicated for an ICD or CRT-D. GDDT was used in 14,892 of 36,358 (41.0%) CRT-D indicated patients and in 14,904 of 101,118 (14.7%) ICD-indicated patients. While GDDT use was low, 95.7% had echocardiography and 92.1% had prescriptions for beta-blockers or angiotensin-converting enzyme/angiotensin-receptor blockers medications.
Conclusions:
In this modern cohort of HF patients, a large proportion of eligible patients did not receive ICDs or CRT-Ds, while frequently receiving other indicated cardiovascular interventions and treatments.
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