Eligibility for cardiac resynchronization therapy in patients hospitalized with heart failure.

AIMS: Recent guidelines recommend cardiac resynchronization therapy (CRT) in mildly symptomatic heart failure (HF) but favour left bundle branch block (LBBB) morphology in patients with moderate QRS prolongation (120-150 ms). We defined how many patients hospitalized with HF fulfil these criteria.

METHODS AND RESULTS: A single-centre retrospective cohort study of 363 consecutive patients hospitalized with HF (438 admissions) was performed. Electronic imaging, electrocardiograms, and records were reviewed. Overall, 153 patients (42%) had left ventricular ejection fraction (LVEF) ≤ 35%, and 34% of patients had QRS prolongation. Eighty patients (22%) were potentially eligible with LVEF ≤ 35% and QRS ≥ 120 ms or existing CRT. The majority (68 of 80) had a Class I or IIa recommendation according to international guidelines (LBBB or non-LBBB QRS ≥ 150 ms or right ventricular pacing). Only a minority (12 of 80) had moderate QRS prolongation of non-LBBB morphology. One-quarter (n = 22) of patients fulfilling criteria were ineligible for reasons including dementia, co-morbidities, or palliative care. A further eight patients required optimization of medical therapy. CRT was therefore immediately indicated in 50 patients. Of these, 29 were implanted or had existing CRT systems. Twenty-one of the 80 patients eligible for CRT were not identified or treated (6% of the total hospitalized cohort).

CONCLUSIONS: Twenty-two per cent of elderly real-life patients hospitalized with HF fulfil LVEF and QRS criteria for CRT, most having a Class I or IIa indication. However, a large proportion is ineligible owing to co-morbidities or requires medical optimization. Although uptake of CRT was reasonable, there remain opportunities for improvement.