Cardiac resynchronization therapy: implant rates, temporal trends and relationships with heart failure epidemiology

Giuseppe Boriania , Elena Bertib , Laura Maria Beatrice Belottib , Mauro Biffia , Angelo Carbonic , Alberto Bandinid , Edoardo Casalie , Corrado Tomasif , Tiziano Tosellig , Paolo Baraldih , Nicola Bottonii , Gaetano Barbatoj , Biagio Sassonek , on behalf of RERAI (Registry of Emilia Romagna on Arrhythmia Interventions) Investigators

Background Consensus guidelines define indications for
cardiac resynchronization therapy (CRT), but the variability
in implant rates in ‘real world’ clinical practice, as well as the
relationship with the epidemiology of heart failure are not
defined.
Methods and results In Emilia-Romagna, an Italian region
with around 4.4 million inhabitants, a registry was instituted
to collect data on implanted devices for CRT, with (CRT-D) or
without defibrillation (CRT-P) capabilities. Data from all
consecutive patients resident in this region who underwent
a first implant of a CRT device in years 2006–2010 were
collected and standardized (considering each of the nine
provinces of the region). The number of CRT implants
increased progressively, with a 71% increase in 2010
compared to 2006. Between 84 and 90% of implants were
with CRT-D devices. The variability in standardized implant
rates among the provinces was substantial and the ratio
between the provinces with the highest and the lowest
implant rates was always greater than 2. Considering
prevalent cases of heart failure in the period 2006–2010,
the proportion of patients implanted with CRT per year
ranged between 0.23 and 0.30%.
Conclusions The application in ‘real world’ clinical practice
of CRT in heart failure is quite heterogeneous, with
substantial variability even among areas belonging to
the same region, with the need to make the access
to this treatment more equitable. Despite the
increased use of CRT, its overall rate of adoption is low,
if a population of prevalent heart failure patients is
selected on the basis of administrative data on
hospitalizations.

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