Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care

Wilfried Mullens*, Angelo Auricchio, Pieter Martens, Klaus Witte, Martin R Cowie, Victoria Delgado, Kenneth Dickstein, Cecilia Linde, Kevin Vernooy, Francisco Leyva, Johann Bauersachs, Carsten W Israel, Lars H Lund, Erwan Donal, Giuseppe Boriani, Tiny Jaarsma, Antonio Berruezo, Vassil Traykov, Zaheer Yousef, Zbigniew KalarusJens Cosedis Nielsen, Jan Steffel, Panos Vardas, Andrew Coats, Petar Seferovic, Thor Edvardsen, Hein Heidbuchel, Frank Ruschitzka, Christophe Leclercq

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post-implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains: (i) overcoming CRT under-utilization, (ii) better understanding of pre-implant characteristics, (iii) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (iv) implementing a dedicated post-implant CRT care pathway.

Original languageEnglish
Pages (from-to)1324-1342
Number of pages19
JournalEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology
Volume23
Issue number8
Early online date5 Feb 2021
DOIs
Publication statusPublished - 1 Aug 2021

Keywords

  • Cardiac resynchronization therapy
  • Care pathways
  • Disease management
  • Disease modification
  • Heart failure
  • Implementation
  • Outcome
  • Response
  • Utilization

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