Barriers to cardiac device access in heart failure patients: a multicenter study in Mexico

To describe the sociodemographic and clinical characteristics of patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF), assess adherence to 2017 ACC/AHA/HRS guidelines, and identify access barriers to cardiac implantable electronic devices (CIEDs).

This multicenter observational cohort study was conducted from January 2020 to May 2022 and involved adults 18+ with HF and LVEF ≤ 45% across seven hospitals. It collected data on sociodemographic, clinical, pharmacological, and CIED characteristics. The analysis was conducted using descriptive statistics.

The study included 253 HF patients, 72% men, with an average age of 64. Main comorbidities were hypertension (62.8%), diabetes (44.3%), and overweight/obesity (60%). Most received beta-blockers (83.8%), angiotensin II receptor blockers (63.6%), and angiotensin receptor-neprilysin inhibitors (51.8%). Of 162 patients with LVEF ≤ 35%, 18.5% had CIEDs. Over 12 months, 75 patients (76.3%) were eligible for CIEDs and 2 (2.1%) for upgrades. Only four (5.3%) were implanted according to guidelines. The main reasons for not implanting CIEDs were care process issues. Many were on waiting lists (29.3%) or in evaluation (26.7%). In addition, 13% faced financial hardship or transportation costs.

In Mexico, the use of CIEDs is low among HF patients with LVEF ≤ 35% due to poor adherence to guidelines and access barriers.