Cardiac resynchronization therapy for enabling guideline-directed medical therapy optimization in heart failure

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Updated: Jan 18, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

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Daniela Tomasoni1,2, Lina Benson1,3, Paolo Gatti3

  • 1Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.

European Journal of Heart Failure
|June 5, 2025
PubMed

Insights

Cardiac resynchronization therapy (CRT) improves guideline-directed medical therapy (GDMT) in heart failure patients. CRT enables better medication use and reduces diuretic needs in heart failure with reduced ejection fraction (HFrEF).

Area of Science:

  • Cardiology
  • Heart Failure Management
  • Medical Device Therapy

Background:

  • Guideline-directed medical therapy (GDMT) is crucial for managing heart failure with reduced ejection fraction (HFrEF).
  • Optimization of GDMT can be challenging in clinical practice.
  • Cardiac resynchronization therapy (CRT) is an established treatment for select HFrEF patients.

Purpose of the Study:

  • To evaluate if cardiac resynchronization therapy (CRT) facilitates the optimization of guideline-directed medical therapy (GDMT) in patients with HFrEF.
  • To assess the impact of CRT on the utilization and dosage of key heart failure medications.

Main Methods:

  • A nationwide, real-world study using the Swedish Heart Failure Registry (2009-2022).
  • Comparison of HFrEF patients receiving CRT (cases) versus those with an indication but not receiving CRT (controls).
  • Intention-to-treat and per-protocol analyses were conducted to assess medication use and dosage at 1.5-year follow-up.

Main Results:

  • Patients receiving CRT showed improved use/dose of beta-blockers and reduced use/dose of loop diuretics compared to controls.
  • These associations remained significant after statistical adjustments and in per-protocol analysis.
  • CRT implantation was also linked to increased likelihood of optimizing ACEi/ARB/ARNi and MRA therapy.

Conclusions:

  • Cardiac resynchronization therapy (CRT) implantation is associated with improved adherence and dosage of GDMT in HFrEF patients.
  • CRT enables optimization of GDMT, including beta-blockers, ACEi/ARB/ARNi, and MRAs.
  • CRT use correlates with a decreased need for loop diuretics in HFrEF management.
Abstract

Keywords:
Cardiac resynchronization therapyGuideline‐directed medical therapyHeart failureLoop diureticsOptimization

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