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Association between demographic, organizational, clinical, and socio-economic characteristics and underutilization of cardiac resynchronization therapy: results from the Swedish Heart Failure Registry.
Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
Karolinska Institutet, Department of Clinical Science and Education, South Hospital, Stockholm, Sweden.
Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
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2017 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) but may be underutilized. The reasons are unknown.

METHODS AND RESULTS: We linked the Swedish Heart Failure Registry to national registries with ICD-10 (International Classification of Diseases-10th Revision) co-morbidity diagnoses and demographic and socio-economic data. In patients with EF ≤39% and NYHA II-IV, we assessed prevalence of CRT indication and CRT use. In those with CRT indication, we assessed the association between 37 potential baseline covariates and CRT non-use using multivariable generalized estimating equation (GEE) models. Of 12 807 patients (mean age 71 ± 12 years, 28% female), 841 (7%) had CRT, 3094 (24%) had an indication for but non-use of CRT, and 8872 (69%) had no indication. Important variables independently associated with CRT non-use were: HF duration <6 months [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.17-1.24]; non-cardiology planned follow-up (RR 1.14, 95% CI 1.09-1.18); age >75 years (RR 1.13, 95% CI 1.09-1.18); non-cardiology care at baseline (RR 1.10, 95% CI 1.07-1.14); small-town non-university centre (RR 1.08, 95% CI 1.05-1.12); female sex (RR 1.07 95% CI 1.03-1.10) (all P < 0.05); as was absence of AF, living alone; psychiatric diagnosis; smoking; and non-use of HF drugs. Education, income, cancer, or HF characteristics were not independently associated with CRT non-use.

CONCLUSION: In this population-wide HF registry, CRT was underutilized. Non-use was associated mostly with demographic and organizational, but not clinical or socio-economic factors. This calls for programmes to raise awareness of CRT indications and improve access and referrals to cardiology specialists.

Place, publisher, year, edition, pages
2017.
Keyword [en]
Cardiac resynchronization therapy, Epidemiology, Guidelines, Heart failure, Implementation, Utilization
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-139104DOI: 10.1002/ejhf.781PubMedID: 28176416OAI: oai:DiVA.org:liu-139104DiVA: diva2:1118662
Available from: 2017-07-01 Created: 2017-07-01 Last updated: 2017-07-01

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Dahlström, Ulf
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Division of Cardiovascular MedicineDepartment of Cardiology in LinköpingFaculty of Medicine and Health Sciences
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