Division of Cardiology, University of Calgary, Calgary, Alberta, Canada.
Canadian VIGOUR Centre and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
JACC Heart Fail. 2017 May;5(5):388-392. doi: 10.1016/j.jchf.2017.02.018.
This study sought to ascertain the impact of heart failure (HF) guideline change on the number of patients eligible to undergo cardiac resynchronization therapy (CRT).
The 2013 HF guideline of the American College of Cardiology Foundation and American Heart Association (ACCF/AHA) narrowed the recommendations for CRT. The impact of this guideline change on the number of eligible patients for CRT has not been described.
Using data from Get With The Guidelines-Heart Failure between 2012 and 2015, this study evaluated the proportion of hospitalized patients with HF who were eligible for CRT on the basis of historical and current guideline recommendations. The authors identified 25,102 hospitalizations for HF that included patients with a left ventricular ejection fraction (LVEF) ≤35% from 283 hospitals. Patients with a medical, system-related, or patient-related reason for not undergoing CRT were excluded.
Overall, 49.1% (n = 12,336) of patients with HF, an LVEF ≤35%, and no documented contraindication were eligible for CRT on the basis of historical guidelines, and 33.1% (n = 8,299) of patients were eligible for CRT on the basis of current guidelines, a 16.1% absolute reduction in eligibility (p < 0.0001). Patients eligible for CRT on the basis of current guidelines were more likely to have CRT with an implantable cardioverter-defibrillator or CRT with pacing only placed or prescribed at discharge (57.8% vs. 54.9%; p < 0.0001) compared with patients eligible for CRT on the basis of historical guidelines.
In this population of patients with HF, an LVEF ≤35%, and no documented contraindication for CRT, the current ACCF/AHA HF guidelines reduce the proportion of patients eligible for CRT by approximately 15%.
本研究旨在确定心力衰竭（HF）指南改变对符合心脏再同步治疗（CRT）条件的患者数量的影响。
美国心脏病学会基金会和美国心脏协会（ACCF/AHA）2013 年 HF 指南缩小了 CRT 的推荐范围。该指南改变对 CRT 合格患者数量的影响尚未描述。
本研究使用 2012 年至 2015 年 Get With The Guidelines-Heart Failure 数据库的数据，根据历史和当前指南建议评估了因 HF 住院的患者中符合 CRT 条件的比例。作者从 283 家医院中确定了 25102 例左心室射血分数（LVEF）≤35%的 HF 住院患者。排除因医疗、系统相关或患者相关原因而不能进行 CRT 的患者。
总体而言，根据历史指南，49.1%（n=12336）的 HF、LVEF≤35%且无记录禁忌症的患者符合 CRT 条件，而根据当前指南，33.1%（n=8299）的患者符合 CRT 条件，符合 CRT 的资格绝对减少了 16.1%（p<0.0001）。与符合历史指南 CRT 条件的患者相比，符合当前指南 CRT 条件的患者更有可能在出院时植入式心律转复除颤器或 CRT 加起搏（57.8% vs. 54.9%；p<0.0001）。
在 LVEF≤35%且无 CRT 记录禁忌症的 HF 患者中，当前的 ACCF/AHA HF 指南将符合 CRT 条件的患者比例降低了约 15%。
