Current European practice and routines associated with the implantation of a CRT device described

European Society of CardiologySep 2 2009

By Dr.Nigussie Bogale

The European cardiac resynchronization therapy (CRT) Survey is a joint initiative taken by the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology. Its primary objective is to describe current European practice and routines associated with the implantation of a CRT device with or without an ICD (implantable cardioverter defibrillator) capability in patients with heart failure.

The data collected from the survey provide useful information in CRT for heart failure on patient demographics and selection, clinical characteristics, diagnostic criteria, implantation routines and techniques, short-term outcomes, adverse experience, and assessment of adherence to guideline recommendations. These data should be useful for benchmarking individual patient management and national practice against wider experience. The data from randomised trials of CRT are limited and based largely on selected patients at high-volume centres with experienced operators. In contrast, the European CRT Survey describes current routine practice in CRT implantation based on a wide range of sampling.

Data were collected between 1st November 2008 and 30th June 2009 from 140 volunteer centres in 13 countries (Austria, Belgium, France, Germany, Ireland, Israel, Italy, Netherlands, Norway, Spain, Sweden, Switzerland, UK). Information was provided on consecutive patients successfully implanted with a CRT device with or without an ICD (CRT-P, CRT-D). All patients agreeing to participate will have a follow-up visit approximately one-year after CRT implantation.

Findings

The survey enrolled 2438 patients, with a mean age of 68 years (31% were 75 years or older). There are characteristic differences between those receiving CRT-P and CRT-D; the reasons are many, but it is clear that demographic and economic factors play a part. However, the Survey data show that younger patients, men and those with ischaemic aetiology are more likely to receive a CRT-D device.

The data also show that the cohort is remarkably similar to the cohorts recruited in randomised clinical trials (with a low proportion of women receiving CRT). However, patients in the Survey were older, and more frequently had mild symptoms. A substantial number had a narrow QRS complex (although a broadening is a typical finding in many trials) and more frequently had atrial fibrillation. However, in this real-world population, complication rates were similar to those reported in the randomised trials.

Says lead author Dr Nigussie Bogale from Stavanger University Hospital in Norway: "This European CRT Survey represents a reasonably large sample reflecting current European practice in the use of CRT devices in the management of patients with heart failure. Our findings show that many patients who do not strictly conform to current guideline recommendations frequently receive a CRT device. Clinicians, researchers and healthcare providers should find these data useful in designing strategies for patient management, trial design and resource allocation."