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U.S. Hospitals Underutilize Proven Heart Failure Therapy

They don't use CRT pacing devices as they should or follow published guidelines, study finds
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By Kevin McKeever

Monday, August 11, 2008

HealthDay news imageMONDAY, Aug. 11 (HealthDay News) -- Cardiac resynchronization therapy (CRT) can help heart failure patients' hearts beat more efficiently and effectively, but most U.S. hospitals don't use it as it should be used, a new report finds.

CRT involves doctors implanting a device that paces the heart's main chambers to beat in sync.

"Studies have shown that, when used in combination with optimal medical therapy, CRT is associated with a 50 percent reduction in hospitalization for heart failure and a 36 percent reduction in mortality, or death," study author Dr. Adrian F. Hernandez, an assistant professor of medicine in the Duke Clinical Research Institute at Duke University, said in a news release. "We did this study to analyze if and how this new therapy is being used in U.S. hospitals."

According to the published analysis of 33,898 heart failure patients admitted to hospitals between January 2005 through September 2007, only 12.4 percent were discharged with CRT.

"That's a small percentage when you consider that we estimate 30 percent to 50 percent of hospitalized patients with heart failure were eligible for CRT based on previous studies," Hernandez said.

Those who did receive the devices tended to have more severe heart failure, as well as a history of heart attacks (58 percent in the CRT group versus 45 percent in the non-CRT group). They also tended to have a history of atrial fibrillation (38 percent versus 27 percent).

While clinical trials have shown that CRT helps patients with a left ventricular ejection fraction (LVEF) -- which shows how well the heart pumps -- of 35 percent or less, only 14.3 percent of the patients with this condition received CRT.

"That means that there are a lot of patients who potentially could benefit from the device who aren't receiving it," Hernandez said. "We also found that 10 percent of patients discharged with a new CRT implant had an LVEF of greater than 35 percent, which suggests that those patients are over-treated. They have not been shown in trials to benefit from the therapy."

Geography and race may play a role in whether CRT is used. For example, heart failure patients treated at northeastern U.S. hospitals were 60 percent less likely to receive CRT than those in other U.S. regions. Black patients were 55 percent less likely than whites to receive the devices.

Hernandez said the findings show that hospitals need to have "systematic practices" to employ best evidence. He also said heart failure patients should investigate their own condition and be their own advocate to get optimal care.

The study findings were published in the Aug. 12 issue of Circulation: Journal of the American Heart Association.


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