CRT-D Use in the U.S. Is Not Always Guideline Concordant

Implantation of cardiac resynchronization therapy defibrillators were labeled as not appropriate in 27% of patients in an analysis of a national data registry.

Cardiac resynchronization therapy (CRT) can improve outcomes in patients with heart failure. Various cardiac guidelines agree that patients with heart failure, left bundle branch block (LBBB), and a QRS width >150 milliseconds should be offered CRT. In an analysis of the National Cardiovascular Data Registry for implantable cardioverter-defibrillators, investigators sought to determine how frequently CRT defibrillators (CRT-Ds) are employed outside guideline recommendations (J Am Coll Cardiol 2013; 61:e6).

Guideline-discordant care was defined as the use of CRT-D in patients with New York Heart Association Class I/II functional status, non-LBBB QRS morphology, and a QRS duration <150 milliseconds or in patients with an ejection fraction >35%…

Reviewing Author

Harlan M. Krumholz, MD, SM

Disclosures

Consultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime

EquityHugo Health; Refactor Health; Element Science

Grant/Research SupportPfizer; Agency for Healthcare Research and Quality; Janssen Research and Development, National Institute of Biomedical Imaging and Engineering; National Heart, Lung, and Blood Institute; Centers for Disease Control and Prevention; National Cancer Institute; American Heart Association

Harlan M. Krumholz, MD, SM

Disclosures

Consultant/Advisory BoardUnited Healthcare; Element Science; Eyedentifeye, F-Prime

EquityHugo Health; Refactor Health; Element Science

CRT-D Use in the U.S. Is Not Always Guideline Concordant

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Reviewing Author