Factors associated with improvement in utilization of cardiac resynchronization therapy in eligible heart failure patients: Findings from IMPROVE HF

Ashish Shukla, Anne B. Curtis, Mandeep R. Mehra, Nancy M. Albert, Mihai Gheorghiade, J. Thomas Heywood, Yang Liu, Christopher M. O'Connor, Dwight Reynolds, Mary Norine Walsh, Clyde W Yancy, Gregg C. Fonarow*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background There is a well-recognized gap between the number of patients in whom cardiac resynchronization therapy (CRT) is indicated based on current guidelines and its actual utilization. In the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) study, there was a significant increase in the use of CRT at 24 months in patients with heart failure (HF) in comparison to baseline. This study evaluated patient, physician, and practice factors associated with this increase in CRT utilization. Methods Patients with reduced left ventricular ejection fraction and chronic HF who met the eligibility criteria for CRT at baseline and 24 months were analyzed. Multivariate analyses using patient, physician, and practice characteristics were performed to evaluate factors associated with increased CRT utilization at 24 months. Results There were 440 patients eligible for CRT both at baseline and 24 months, with 217 (49.3%) treated at baseline and 374 (85%) treated at 24 months, leading to an absolute increase in use of CRT of 35.7%, P < 0.001. Although serum sodium and the absence of rales had modest associations, none of the patient, physician, or practice characteristics had any significant association with the extent of increase in CRT utilization. There was a significant reduction in the variation of CRT utilization across practice sites after the implementation of the performance improvement initiative. Conclusions The performance improvement initiative in IMPROVE HF was the most important factor associated with an increase in guideline-recommended CRT utilization. This improvement in CRT utilization and reduced practice variability was found across a variety of cardiology and multispecialty practice sites.

Original languageEnglish (US)
Pages (from-to)433-443
Number of pages11
JournalPACE - Pacing and Clinical Electrophysiology
Volume36
Issue number4
DOIs
StatePublished - Apr 2013

Keywords

  • Cardiac resynchronization therapy
  • guideline adherence
  • heart failure
  • humans
  • mortality
  • utilization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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