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Normand C, Linde C, Blomström-Lundqvist C, Stellbrink C, Gasparini M, Anker SD, Plummer C, Sarigul NU, Papiashvili G, Iovev S, Dickstein K. Adherence to ESC cardiac resynchronization therapy guidelines: findings from the ESC CRT Survey II. Europace 2020; 22:932-938. [PMID: 32330937 DOI: 10.1093/europace/euaa067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/11/2019] [Accepted: 03/09/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients with heart failure (HF) and electrical dyssynchrony. The European Society of Cardiology (ESC) Guidelines provide evidence-based recommendations indicating optimal patient selection for CRT implantation in both the 2013 European Heart Rhythm Association (EHRA) and the 2016 Heart Failure Association (HFA) Guidelines. We assessed the adherence to guidelines and identified factors associated with guideline adherence. METHODS AND RESULTS In 2016, the HFA and EHRA conducted the CRT Survey II in 42 ESC countries. The data collected were sufficient to evaluate adherence to guidelines in 8021 patients. Of these, 67% had a Class I guideline indication for CRT implantation, which was significantly correlated with female gender (1.70, P < 0.0001), age <75 years (1.55, P < 0.0001), non-ischaemic HF aetiology (1.22, P < 0.0001), and elective admission (1.87, P < 0.0001). A further 26% of implants had a Class IIa indication, 5% IIb and only 2% a contraindication to CRT-a Class III indication. Patients implanted under Level IIa indications were much more likely to have more comorbidities than patients implanted under Level I indications. However, there were large variations in guideline adherence between ESC countries. CONCLUSION Implanters in ESC member states demonstrate a high degree of adherence to ESC guidelines with 98% of implants having a documented Class I, IIa or IIb indication. Cardiac resynchronization therapy implantation without a Class I indication was more likely in men, patients age ≥75 years, with HF of ischaemic origin and in patients admitted to hospital acutely.
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Affiliation(s)
- Camilla Normand
- Cardiology Division, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | - Maurizio Gasparini
- Department of Cardiology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Stefan D Anker
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Chris Plummer
- Department of Cardiology, Freeman Hospital, Freeman Rd, Newcastle upon Tyne, UK
| | - Nedim Umutay Sarigul
- Department of Cardiology, Medicalpark Goztepe Hospital, Istanbul, Turkey.,Kardio Bremen, Bremen, Germany
| | - Giorgi Papiashvili
- Arrhythmia Department, Helsicore - Israeli-Georgian Medical Research Clinic, Tbilisi, Georgia
| | - Svetoslav Iovev
- Cardiostimulation and Electrophysiology Sector at "St. Ekaterina" University Multi-profile Hospital for Active Treatment, Sofia, Bulgaria
| | - Kenneth Dickstein
- Cardiology Division, Stavanger University Hospital, Postboks 8100, 4068 Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
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Dickstein K, Normand C, Auricchio A, Bogale N, Cleland JG, Gitt AK, Stellbrink C, Anker SD, Filippatos G, Gasparini M, Hindricks G, Blomström Lundqvist C, Ponikowski P, Ruschitzka F, Botto GL, Bulava A, Duray G, Israel C, Leclercq C, Margitfalvi P, Cano Ó, Plummer C, Sarigul NU, Sterlinski M, Linde C. CRT Survey II: a European Society of Cardiology survey of cardiac resynchronisation therapy in 11 088 patients-who is doing what to whom and how? Eur J Heart Fail 2018; 20:1039-1051. [PMID: 29457358 DOI: 10.1002/ejhf.1142] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 12/22/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008-2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT. METHODS AND RESULTS A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed. CONCLUSION CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy.
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Affiliation(s)
- Kenneth Dickstein
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Camilla Normand
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway.,Institute of Internal Medicine, University of Bergen, Bergen, Norway
| | - Angelo Auricchio
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Nigussie Bogale
- Cardiology Division, Stavanger University Hospital, Stavanger, Norway
| | - John G Cleland
- Robertson Centre for Biostatistics and Clinical Trials, University of Glasgow and National Heart & Lung Institute, Imperial College London, UK
| | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.,Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.,University of Cyprus, School of Medicine, Cyprus
| | | | - Stefan D Anker
- Division of Cardiology and Metabolism; Department of Cardiology (CVK); Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany.,Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Athens University Hospital Attikon, Athens, Greece
| | | | - Gerhard Hindricks
- Department of Cardiac Surgery, HELIOS Heart Center Leipzig, Leipzig, Germany
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Medical University Wroclaw, Wroclaw, Poland
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Alan Bulava
- Department of Cardiology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic.,Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic.,Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Gabor Duray
- Clinical Electrophysiology, Department of Cardiology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Carsten Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany
| | | | - Peter Margitfalvi
- The National Institute of Cardiovascular Diseases, Bratislava, Slovak Republic
| | - Óscar Cano
- Unidad de Arritmias, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Chris Plummer
- Department of Cardiology, Freeman Hospital, Freeman Rd, Newcastle upon Tyne, UK
| | - Nedim Umutay Sarigul
- Department of Cardiology, Medicalpark Goztepe Hospital, Istanbul, Turkey.,Kardio Bremen, Bremen, Germany
| | | | - Cecilia Linde
- Heart and Vessels Theme, Karolinska University Hospital, Stockholm, and Karolinska Institutet, Stockholm, Sweden
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