Impact of Current Versus Previous Cardiac Resynchronization Therapy Guidelines on the Proportion of Patients With Heart Failure Eligible for Therapy

Structured Abstract Background The 2013 heart failure (HF) guidelines of the American College of Cardiology Foundation and American Heart Association (ACCF-AHA) narrow the recommendations for cardiac resynchronization therapy (CRT). The impact of this guideline change on the number of eligible patients for CRT has not been described. Methods Using data from Get With The Guidelines-HF between 2012 and 2015, we evaluated the proportion of hospitalized patients with HF eligible for CRT based on Historic and Current guideline recommendations. We identified 25,102 hospitalizations for HF that included patients with a left ventricular ejection fraction (LVEF) ≤ 35% from 283 hospitals. Patients with a medical, system or patient-related reason for not prescribing CRT were excluded. Results Overall, 49.1% (n=12,336) of HF patients with LVEF ≤ 35% and without a documented contraindication were eligible for CRT based on Historic guidelines and 33.1% (n=8,299) of patients were eligible for CRT based on Current guidelines, a 16.1% absolute reduction in eligibility, P Conclusions In this HF population with LVEF ≤ 35% and without a documented contraindication for CRT, the Current ACCF-AHA HF guidelines reduce the proportion of patients eligible for CRT by approximately 15%.