Guideline-Directed Medical Therapy in Patients After Implantation of Implantable Cardioverter Defibrillators to...

Despite its well established benefits, guideline-directed medical therapy (GDMT) is often underutilized following cardiac implantable electronic device (CIED) implantation. We sought to determine the rate of use of GDMT and whether a specialized intervention could improve GDMT and heart failure (HF) outcomes in a CIED clinic.

This prospective quasi-experimental observational cohort study was performed from July 2020 to April 2022. Patients were included if they had a CIED with a left ventricular ejection fraction (LVEF) ≤ 35%. The intervention consisted of a 12-month program in a specialized heart function clinic and device optimization. Controls were patients who were eligible but did not participate in the intervention. The outcome measures were improvement in GDMT use, N-terminal pro-B type natriuretic peptide level (NTproBNP), New York Heart Association class, LVEF, and HF-related emergency department visits and/or hospitalizations.

After screening of 942 patients, 220 were identified as having an LVEF ≤ 35%, of which 58% were not on GDMT (intervention n = 29; control n = 99). In the intervention group, 54% of patients reached 4 classes of GDMT, compared to 2.1% of the control group (P < 0.001). HF-related emergency department visits and/or hospitalization were significantly reduced in the intervention group (3.4% vs 14.1%, P = 0.018). NT-proBNP level was reduced by 25%, and LVEF increased by 6.5% in the intervention group. No difference in mortality was noted.

This study demonstrates that a specialized HF intervention, designed to optimize GDMT in patients with CIEDs, was associated with an improved NTproBNP level and fewer HF-related emergency department visits and/or hospitalizations, highlighting an important addressable gap in the management of CIED patients.