Comparative Analysis of ICD/CRT-D Utilization and Outcomes: MEAREE Registry vs European Registries

Background Implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) are standard therapies for preventing sudden cardiac death (SCD). While European registries, such as ESC EORP Heart Failure III, DEVICE, and ESC-CRT Survey II, have described ICD/CRT-D use in real-world clinical practice in European countries, data from emerging economies remain scarce. The MEAREE registry provides real-world insights from the Middle East, Africa, Eastern Europe, and Commonwealth of Independent States (CIS). Methods MEAREE was a prospective, observational, multicenter registry enrolling 747 patients undergoing first-time ICD/CRT-D implantation between February 2022 and December 2024, across 28 centers in 15 countries. Baseline demographics, device type, and 12-month outcomes were analyzed descriptively and compared with published data from the ESC EORP HF III, DEVICE Registry, and ESC-CRT Survey II data. Results MEAREE patients had a median age of 62 years compared to 67 years in ESC registries and were predominantly male (78%). Primary prevention accounted for 70% of implants overall, with substantial regional variation (Middle East 90.9%, Africa 33.2%), compared to 80% in Europe. Device distribution showed ICD implantation in 71.7% and CRT-D in 28.3% of patients, whereas CRT-D penetration was 30–35% in the ESC DEVICE Registry and 80% in the ESC-CRT Survey II. At 12 months, all-cause mortality was 1.2% in MEAREE vs 5–8% in European registries. Appropriate ICD shocks occurred at 4.1 per 100 patient-years comparable to European rates (5–6 per 100 patient-years), while inappropriate shocks were 2.0 in MEAREE vs 3–4 per 100 patient-years in European Registries). Adverse events were reported in 4.7% of MEAREE patient’s vs 8–10% in ESC Registries. Device malfunction was rare (0.7%). Functional improvement was observed, with NYHA class I increase from 7% at baseline to 15% at 12 months. Conclusion MEAREE demonstrates lower mortality and adverse event rates than European registries, likely reflecting younger age and other patients characteristics differences. Regional disparities in device selection highlight the need for tailored strategies to optimize ICD/CRT-D utilization globally. These findings highlight the importance of expanding real-world evidence from emerging regions to guide equitable and effective device-based therapy implementation.