Timing of Cardiac Resynchronization Therapy Following Stable Medical Therapy in Patients With Heart Failure
Alessandro Villaschi1, Christian Basile2, Lina Benson3
1Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
JACC. Heart Failure
|June 21, 2025
Summary
Implanting cardiac resynchronization therapy (CRT) within 3 months of stable medical therapy (SMT) for heart failure (HF) is linked to better outcomes. Delayed CRT beyond 3 months increases cardiovascular death and hospitalization risks.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Existing guidelines recommend cardiac resynchronization therapy (CRT) for select heart failure (HF) patients.
- Optimal timing for CRT implantation after achieving stable medical therapy (SMT) remains unclear, impacting patient outcomes.
Purpose of the Study:
- To examine the timing of CRT implantation relative to SMT achievement in a real-world HF cohort.
- To identify patient profiles associated with varying CRT implantation times.
- To analyze the association between CRT timing and clinical outcomes, including mortality and morbidity.
Main Methods:
- Retrospective analysis of 9,409 HF patients from the Swedish ICD and Pacemaker Registry (2007-2020).
- Multivariable logistic regression identified factors influencing time to CRT implantation.
- Multivariable Cox regression assessed the relationship between SMT-to-CRT interval and outcomes (mortality/morbidity).
Main Results:
- 43.8% of patients received CRT within 3 months of SMT, 34.9% between 3-9 months, and 21.3% after 9 months.
- Shorter time to CRT was associated with recent HF hospitalization and defibrillator use.
- Delayed CRT (>9 months) significantly increased risks of cardiovascular death/HF hospitalization (13%) and cardiovascular death (12%).
Conclusions:
- The time from achieving SMT to CRT implantation has decreased over time.
- Delaying CRT implantation beyond 3 months post-SMT optimization is associated with increased cardiovascular mortality.
Related Concept Videos
01:22Heart Failure VI: Adjunct Therapies
39
Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
39
01:30Cardiomyopathy II: Dilated Cardiomyopathy
30
Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
30
01:30Heart Failure V: Medical Management
34
Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
34
01:21Rheumatic Heart Disease III: Medical Management
36
Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
36
01:29Cardiomyopathy V: Interprofessional Care
41
Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
41
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
65
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
65