Department of Cardiology, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands.
ESC Heart Fail. 2020 Aug;7(4):1771-1780. doi: 10.1002/ehf2.12740. Epub 2020 May 12.
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.
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).
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.
尽管之前有调查研究过心力衰竭（HF）患者中设备植入率，但对于设备实际管理情况的了解仍很有限。因此，我们调查了 34 家荷兰中心左心室射血分数（LVEF）降低的 HF 患者中设备植入率。
对 LVEF<50%且有设备植入信息的 6666 例患者进行了一项横断面门诊登记[年龄 74（66-81）岁；64%为男性]。患者分为传统起搏器（PM，n=562）、植入式心律转复除颤器（ICD，n=1165）、具有除颤功能的心脏再同步治疗（CRT-D，n=885）或仅具有起搏功能的心脏再同步治疗（CRT-P，n=248）或无设备（n=3806）。中心分为 ICD 植入中心和 CRT 植入中心及转诊中心。总体而言，17.5%的患者植入了 ICD，13.3%植入了 CRT-D，3.7%植入了 CRT-P，8.4%植入了 PM。在 LVEF≤30%的患者中，42.5%接受了 ICD 或 CRT-D 治疗。各中心之间的植入率差异很大：ICD 治疗的植入率为 3-51%，CRT-D 治疗的植入率为 0.3-44%，CRT-P 治疗的植入率为 0-11%，PM 治疗的植入率为 0-25%。与转诊中心相比，植入中心 ICD、CRT-D 和 CRT-P 的植入率更高[分别为 36%比 25%用于除颤器（ICD 或 CRT-D）和 17%比 9%用于 CRT 设备（CRT-D 或 CRT-P），P<0.001]，这与其他因素无关。大量临床因素与设备使用相关。其他因素中，LVEF<40%和男性是 ICD/CRT-D 使用的独立正预测因素[比值比（OR）分别为 3.33，P<0.001；OR 为 1.87，P=0.019]。年龄较大与 ICD/CRT-D 使用率较低相关（OR 为每年 0.96，P<0.001），而与 CRT-P/PM 使用率较高相关（OR 为每年 1.03，P=0.006）。
在这项大型荷兰 HF 注册研究中，即使 LVEF 为≤30%，也只有不到一半的 LVEF 降低的 HF 患者接受了 ICD 或 CRT 治疗，且各中心之间的差异很大。来自植入中心的患者更常接受 ICD 或 CRT 治疗。在临床实践中，需要更一致地使用设备治疗指南。
