Published Online
on August 12, 2008

A more recent version of this article appeared on August 26, 2008

This Article Full Text (PDF) CME: Take the course for this article: Circulation: August 26, 2008, Volume 118, Number 9 All Versions of this Article: 118/9/926    most recent CIRCULATIONAHA.108.773838v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Piccini, J. P. Search for Related Content PubMed PubMed Citation Articles by Piccini, J. P. Related Collections Congestive Pacemaker Related Article

Submitted on February 15, 2008
Accepted on June 20, 2008

Use of Cardiac Resynchronization Therapy in Patients Hospitalized With Heart Failure

Jonathan P. Piccini MD, Adrian F. Hernandez MD, MHS^*, David Dai PhD, MS, Kevin L. Thomas MD, William R. Lewis MD, Clyde W. Yancy MD, Eric D. Peterson MD, MPH, Gregg C. Fonarow MD, for the Get With the Guidelines Steering Committee and Hospitals

From the Duke Clinical Research Institute, Durham, NC (J.P.P., A.F.H., D.D., K.L.T., E.D.P.); MetroHealth Medical Center, Cleveland, Ohio (W.R.L.); Baylor Heart and Vascular Institute, Dallas, Tex (C.W.Y.); and University of California Los Angeles Medical Center, Los Angeles (G.C.F.).

^* To whom correspondence should be addressed. E-mail: adrian.hernandez{at}duke.edu.

Background—The frequency and characterization of patients receiving cardiac resynchronization therapy (CRT) are largely unknown since the publication of pivotal clinical trials and subsequent incorporation of CRT into the American College of Cardiology/American Heart Association guidelines for heart failure.

Methods and Results—We analyzed 33 898 patients admitted from January 2005 through September 2007 to 228 hospitals participating in the American Heart Association's Get With the Guidelines–Heart Failure program. There were 4201 patients (12.4%) discharged alive with CRT, including 811 new implants. Patients discharged with CRT were older (median age, 75 versus 72 years) and had lower median left ventricular ejection fraction (30% versus 38%), more frequent ischemic cardiomyopathy (58% versus 45%), more history of atrial fibrillation (38% versus 27%), and higher rates of -blocker and aldosterone antagonist use (P<0.0001 for all) than those without CRT. We found that 4.8% of patients with left ventricular ejection fraction 35% were discharged with a new CRT implant, which varied greatly by hospital. Ten percent of patients discharged with a new CRT implant had a left ventricular ejection fraction >35%. Major factors associated with lower rates of new CRT placement were treatment in the northeast (odds ratio, 0.40; 95% confidence interval, 0.30 to 0.53), black race (odds ratio, 0.45; 95% confidence interval, 0.36 to 0.57), increasing left ventricular ejection fraction per 10% (odds ratio, 0.56; 95% confidence interval, 0.52 to 0.60), and increasing age per 10 years in those >70 years of age (odds ratio, 0.56; 95% confidence interval, 0.48 to 0.65).

Conclusions—Although CRT is a recent evidence-based therapy for heart failure, patterns of use differ significantly from clinical trials and published guidelines. Important variations also exist for CRT therapy based on race, geographic region, comorbidities, and age and need to be addressed through further study and/or quality-of-care initiatives.

Key words: heart failure • pacemaker • registries

Related Article:

Clinical Summaries
Circulation 2008 118: 897-898. [Extract] [Full Text]

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