Abstract 10365: Adherence to Guideline-Based Indications and Prevalence of Optimal Medical Therapy Among Patients Receiving Cardiac Resynchronization Therapy Defibrillators in the Outcomes Among Veterans with Implantable Devices Registry
Background: Cardiac resynchronization therapy (CRT) has been shown to reduce morbidity and mortality in properly selected patients on optimal medical therapy. Recent studies have also shown decreased benefit of CRT with sub-optimal medical therapy and a considerable proportion of out of guideline CRT implantation. The proportion of real-world patients undergoing CRT-D implantation who meet guideline-based indications and who are on optimal medical therapy for systolic heart failure have not been well examined.
Methods: Among Veterans enrolled in the Outcomes among Veterans with Implantable Defibrillators (OVID) registry, we calculated the proportion of patients with established Class I indications for CRT-D, the prevalence of optimal medical therapy for heart failure, and the proportion with both established Class I indications for CRT-D and receiving optimal medical therapy for heart failure.
Results: Among patients with complete data regarding Class I indications for CRT-D, 596 (97.4%) had a left ventricular ejection fraction ≤ 35%, 542 (88.6%) had a QRS duration > 120 ms, 569 (93.0%) had New York Heart Association Class III or IV symptoms, and 492 (80.4%) met all 3 criteria. In patients with complete data regarding optimal medical therapy, 833 (94.6%) were prescribed a beta-blocker (BB), 802 (91.0%) were prescribed either an angiotensin converting enzyme inhibitor (ACE-I) or an angiotensin II receptor inhibitor (ARB), and 762 (86.5%) were prescribed both a BB and an ACE-I or ARB. Among 610 patients with complete data for both Class I indications and optimal medical therapy, 436 (71.5%) met Class I indications and were prescribed optimal medical therapy, and eighteen (3.0%) did not meet Class I indications and were not prescribed optimal medical therapy.
Conclusion: Among veterans receiving CRT-D, the proportion of patients meeting guideline-based indications is higher than previously observed in national registries. Additionally, the proportion of veterans receiving optimal medical therapy at the time of CRT-D implantation is high. Whether the prevalence of optimal medical therapy in non-veteran populations is similarly high is unclear.
- © 2011 by American Heart Association, Inc.