Abstract 10420: Utilization of Cardiac Resynchronization Therapy in Patients Hospitalized With Heart Failure: Has it Changed and is it Associated With Patient Outcomes?
Background: Prior work has demonstrated that cardiac resynchronization therapy (CRT) reduces heart failure hospitalization (HFH) and mortality particularly in patients who are female, have non-ischemic disease, low ejection fraction and wide QRS. However, patterns of use in clinical practice remain largely unknown. We investigated temporal trends in the utilization of CRT among patients hospitalized for HF and assessed whether CRT use was associated with differences in all-cause mortality.
Methods: We included 72,008 patients with EF ≤35% admitted for HFH at 388 sites in the Get With the Guidelines-Heart Failure (GWTG-HF) registry from 2005 - 2014. Using logistic regression we evaluated the association of race, gender, and time with CRT use. Among 15,619 patients linked to Medicare inpatient data 2005 - 2012, Cox proportional hazards models assessed association between CRT and mortality.
Results: The majority of patients were men (60.0%), white (61.9%), and had ischemic heart disease (59.3%). CRT had already been in place, was implanted during admission, or prescribed at discharge in 26.3% of patients. Women were less likely to have CRT than men over time, and black patients were consistently less likely than white patients to receive CRT. (Figure) CRT was associated with reduced mortality during the study period (hazard ratio [95% confidence interval]) (HR [CI]) (0.90 [0.84, 0.96]), p=0.002, and there was a trend towards increased benefit in more recent years (p-interaction=0.06, (2011-2012) (HR [CI]) (0.82 [0.73 - 0.92]).
Conclusions: CRT use has increased, but it continues to be underutilized in many HF patients. A new gender disparity has developed despite evidence that women are more likely than men to benefit from CRT. There is an association between CRT and reduced mortality that has strengthened over time. Future initiatives should address the disparity in CRT utilization among women and black patients to help them derive mortality benefit from this therapy.
Author Disclosures: T.C. Randolph: Research Grant; Significant; NIH T32 training grant, Boston Scientific. A.S. Hellkamp: None. E.P. Zeitler: None. P.J. Shulte: None. G.C. Fonarow: Consultant/Advisory Board; Modest; Medtronic, Amgen, Johnson & Johnson, Bayer, Boston Scientific. Research Grant; Significant; NIH. Consultant/Advisory Board; Significant; Novartis. A.F. Hernandez: None. C.W. Yancy: None. E.J. Peterson: None. S.M. Al-Khatib: None.
- © 2015 by American Heart Association, Inc.