Contemporary use of devices in chronic heart failure in the Netherlands.

Autor: Raafs AG; Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands., Linssen GCM; Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands., Brugts JJ; Department of Cardiology, Erasmus Medical Centre, Thoraxcentre, Rotterdam, The Netherlands., Erol-Yilmaz A; Department of Cardiology, Bernhoven Hospital, Uden, The Netherlands., Plomp J; Department of Cardiology, Tergooi, Blaricum/Hilversum, The Netherlands., Smits JPP; Department of Cardiology, Zuwe Hofpoort Hospital, Woerden, The Netherlands., Nagelsmit MJ; Department of Cardiology, Scheper Hospital, Emmen, The Netherlands., Oortman RM; Department of Cardiology, Bravis Hospital, Bergen op Zoom, The Netherlands., Hoes AW; Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht and Utrecht University, Utrecht, The Netherlands., Brunner-LaRocca HP; Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: ESC heart failure [ESC Heart Fail] 2020 Aug; Vol. 7 (4), pp. 1771-1780. Date of Electronic Publication: 2020 May 12.
DOI: 10.1002/ehf2.12740
Abstrakt: Aims: Despite previous surveys regarding device implantation rates in heart failure (HF), insight into the real-world management with devices is scarce. Therefore, we investigated device implantation rates in HF with reduced left ventricular ejection fraction (LVEF) in 34 Dutch centres.
Methods and Results: A cross-sectional outpatient registry was conducted in 6666 patients with LVEF < 50% and with information about device implantation available [74 (66-81) years of age; 64% male]. Patients were classified into conventional pacemakers (PM, n = 562), implantable cardioverter defibrillators (ICD, n = 1165), and cardiac resynchronization therapy with defibrillator function (CRT-D, n = 885) or pacemaker function only (CRT-P, n = 248), or no device (n = 3806). Centres were divided into ICD-implanting and CRT-implanting and referral centres. Overall, 17.5% had an ICD, 13.3% CRT-D, 3.7% CRT-P, and 8.4% PM. Of those with LVEF ≤ 30%, 42.5% had ICD or CRT-D therapy. A large variation in implantation rates existed between centres: 3-51% for ICD therapy, 0.3-44% for CRT-D therapy, 0-11% for CRT-P therapy, and 0-25% PM therapy. Implantation centres showed higher implantation rates of ICD, CRT-D, and CRT-P compared with referral centres [36% vs. 25% for defibrillators (ICD or CRT-D) and 17% vs. 9% for CRT devices (CRT-D or CRT-P), respectively, P < 0.001], independently of other factors. A large number of clinical factors were predictive for device usage. Among other, LVEF < 40% and male sex were independent positive predictors for ICD/CRT-D use [odds ratio (OR) = 3.33, P < 0.001; OR = 1.87, P = 0.019, respectively]. Older age was independently associated with less ICD/CRT-D (OR = 0.96 per year, P < 0.001) and more CRT-P/PM use (OR = 1.03 per year, P = 0.006).
Conclusions: In this large Dutch HF registry, less than half of the patients with reduced LVEF received an ICD or CRT, even if LVEF was ≤30%, and a large variation between centres existed. Patients from implantation centres had more often ICD or CRT. More uniformity regarding guideline-based use of device therapy in clinical practice is needed.
(© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)
Databáze: MEDLINE
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