August 16, 2005
View Full PaperHow many patients with heart failure are eligible for cardiac resynchronization? Insights from two prospective cohorts
Key Result
Trial eligibility criteria for cardiac resynchronization therapy were met by only 1% of heart failure patients in a hospital discharge cohort and 17% in a specialty clinic cohort.
Study Design
Type
Cohort (n=9,405)
Multicenter
Yes
Structured PICO
What proportion of patients with heart failure are eligible for cardiac resynchronization therapy (CRT)?
P
Population
9,405 patients with heart failure from two prospective cohorts: a hospital discharge cohort (n=9,096 discharged alive from 103 hospitals) and a specialty clinic cohort (n=309).
I
Intervention
Assessment of eligibility for cardiac resynchronization therapy (CRT) based on trial criteria (LVEF ≤0.35, QRS ≥120 ms, sinus rhythm, and NYHA class III or IV symptoms despite ACEi/ARB and beta-blocker).
O
Outcome
Proportion of patients eligible for cardiac resynchronization therapy (CRT)
Only a small minority of real-world heart failure patients meet the strict eligibility criteria established by pivotal CRT trials.
Abstract
AIMS: To determine what proportion of patients with heart failure are eligible for cardiac resynchronization therapy (CRT). METHODS AND RESULTS: Eligibility criteria from the trials establishing the efficacy of CRT were applied to two prospective cohorts: the first enrolled patients with newly diagnosed heart failure discharged from 103 hospitals between April 1999 and March 2001 ('the hospital discharge cohort'); the second enrolled patients seen in a specialized clinic between August 2003 and January 2004 ('the specialty clinic cohort'). In the hospital discharge cohort, 73 patients (3% of the 2640 patients with ischaemic or dilated cardiomyopathy and 1% of all 9096 patients with heart failure discharged alive) met trial eligibility criteria: LVEF or =120 ms, sinus rhythm, and NYHA class III or IV symptoms despite the treatment with ACE-inhibitor/angiotensin receptor blocker and beta-blocker. In the specialty clinic cohort, 54 patients (21% of the 263 patients with ischaemic or dilated cardiomyopathy and 17% of all 309 patients with heart failure) met these criteria. If persistent symptoms despite taking spironolactone were required for CRT eligibility, then the proportions qualifying dropped to 1% in the hospital discharge cohort and 18% in the specialty clinic cohort. CONCLUSION: Few heart failure patients meet trial eligibility criteria for CRT.