Utilization and Efficacy of Cardiac Resynchronization Therapy in Patients With Chronic Heart Failure　- A Report From the CHART-2 Study

Overview

Journal Circ Rep

Date 2022 Jul 1

PMID 35774073

Authors

Hideka Hayashi

Satoshi Yasuda

Makoto Nakano

Yasuhiko Sakata

Kotaro Nochioka

Takashi Shiroto

Yuhi Hasebe

Takashi Noda

Satoshi Miyata

Hiroaki Shimokawa

Affiliations

Soon will be listed here.

Abstract

Although cardiac resynchronization therapy (CRT) is effective for patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction and wide QRS (≥120 ms), data on the use of or long-term outcomes after CRT implantation in Japan are limited. We examined proper CRT utilization and outcomes in 3,447 consecutive symptomatic CHF patients registered in the CHART-2 Study. We identified 167 potentially eligible patients and divided them into 4 groups according to the presence (+) or absence (-) of an indication for and implantation of CRT: Group A (reference group), (+)indication/(+)CRT; Group B, (+)indication/(-)CRT; Group C, (-)indication/(+)CRT; and Group D, (-)indication/(-)CRT. Based on the Japanese Circulation Society guidelines, 91 patients met the eligibility for CRT implantation, with 43 (47%) of them undergoing CRT implantation. After adjusting for confounders, age was significantly associated with no CRT use (odds ratio per 5-year increase 1.46; 95% confidence interval 1.11-2.05; P=0.012). Among the 4 groups, the cumulative incidence of cardiovascular death and CHF admission were highest in Group B and lowest in Group D (P=0.029). In this study, only half the eligible CHF patients properly received CRT. Aging was a significant risk factor for no CRT use. Patients without CRT despite having an indication could be at higher risk of mortality and CHF admission.

Citing Articles

Abnormal inter-ventricular diastolic mechanical delay in patients with ST-segment elevation myocardial infarction.

Jin W, Yu C, Wang L, Ma Y, He D, Zhu T BMC Cardiovasc Disord. 2023; 23(1):494.

PMID: 37803312 PMC: 10559586. DOI: 10.1186/s12872-023-03531-1.

References

Heidenreich P, Tsai V, Bao H, Curtis J, Goldstein M, Curtis L . Does Age Influence Cardiac Resynchronization Therapy Use and Outcome?. JACC Heart Fail. 2015; 3(6):497-504. DOI: 10.1016/j.jchf.2015.01.012. View

. Guidelines for Non-Pharmacotherapy of Cardiac Arrhythmias (JCS 2011). Circ J. 2012; 77(1):249-74. DOI: 10.1253/circj.cj-66-0054. View

Nochioka K, Sakata Y, Takahashi J, Miyata S, Miura M, Takada T . Prognostic impact of nutritional status in asymptomatic patients with cardiac diseases: a report from the CHART-2 Study. Circ J. 2013; 77(9):2318-26. DOI: 10.1253/circj.cj-13-0127. View

Shiba N, Nochioka K, Miura M, Kohno H, Shimokawa H . Trend of westernization of etiology and clinical characteristics of heart failure patients in Japan--first report from the CHART-2 study. Circ J. 2011; 75(4):823-33. DOI: 10.1253/circj.cj-11-0135. View

Yasuda S, Miyamoto Y, Ogawa H . Current Status of Cardiovascular Medicine in the Aging Society of Japan. Circulation. 2018; 138(10):965-967. DOI: 10.1161/CIRCULATIONAHA.118.035858. View

Alvarez-Alvarez B, Garcia-Seara J, Martinez-Sande J, Rodriguez-Manero M, Fernandez Lopez X, Gonzalez-Melchor L . Long-term cardiac reverse remodeling after cardiac resynchronization therapy. J Arrhythm. 2021; 37(3):653-659. PMC: 8207409. DOI: 10.1002/joa3.12527. View

Ruschitzka F, Abraham W, Singh J, Bax J, Borer J, Brugada J . Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med. 2013; 369(15):1395-405. DOI: 10.1056/NEJMoa1306687. View

Yokoshiki H, Shimizu A, Mitsuhashi T, Furushima H, Sekiguchi Y, Manaka T . Trends and determinant factors in the use of cardiac resynchronization therapy devices in Japan: Analysis of the Japan cardiac device treatment registry database. J Arrhythm. 2016; 32(6):486-490. PMC: 5129119. DOI: 10.1016/j.joa.2016.04.002. View

Sakata Y, Miyata S, Nochioka K, Miura M, Takada T, Tadaki S . Gender differences in clinical characteristics, treatment and long-term outcome in patients with stage C/D heart failure in Japan. Report from the CHART-2 study. Circ J. 2013; 78(2):428-35. DOI: 10.1253/circj.cj-13-1009. View

10.

Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K . JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J. 2021; 85(7):1104-1244. DOI: 10.1253/circj.CJ-20-0637. View

11.

Miura M, Sakata Y, Miyata S, Nochioka K, Takada T, Tadaki S . Usefulness of combined risk stratification with heart rate and systolic blood pressure in the management of chronic heart failure. A report from the CHART-2 study. Circ J. 2013; 77(12):2954-62. DOI: 10.1253/circj.cj-13-0725. View

12.

Tsutsui H, Tsuchihashi-Makaya M, Kinugawa S, Goto D, Takeshita A . Clinical characteristics and outcome of hospitalized patients with heart failure in Japan. Circ J. 2006; 70(12):1617-23. DOI: 10.1253/circj.70.1617. View

13.

Lund L, Braunschweig F, Benson L, Stahlberg M, Dahlstrom U, Linde C . Association between demographic, organizational, clinical, and socio-economic characteristics and underutilization of cardiac resynchronization therapy: results from the Swedish Heart Failure Registry. Eur J Heart Fail. 2017; 19(10):1270-1279. DOI: 10.1002/ejhf.781. View

14.

Curtis A, Yancy C, Albert N, Stough W, Gheorghiade M, Heywood J . Cardiac resynchronization therapy utilization for heart failure: findings from IMPROVE HF. Am Heart J. 2009; 158(6):956-64. DOI: 10.1016/j.ahj.2009.10.011. View

15.

Moss A, Hall W, Cannom D, Klein H, Brown M, Daubert J . Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009; 361(14):1329-38. DOI: 10.1056/NEJMoa0906431. View

16.

McMurray J, Adamopoulos S, Anker S, Auricchio A, Bohm M, Dickstein K . ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the.... Eur Heart J. 2012; 33(14):1787-847. DOI: 10.1093/eurheartj/ehs104. View

17.

Kron J, Aranda Jr J, Miles W, Burkart T, Woo G, Saxonhouse S . Benefit of cardiac resynchronization in elderly patients: results from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE) and Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE-ICD) trials. J Interv Card Electrophysiol. 2009; 25(2):91-6. DOI: 10.1007/s10840-008-9330-2. View

18.

Yancy C, Jessup M, Bozkurt B, Butler J, Casey Jr D, Drazner M . 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013; 128(16):1810-52. DOI: 10.1161/CIR.0b013e31829e8807. View

19.

Ambrosy A, Fonarow G, Butler J, Chioncel O, Greene S, Vaduganathan M . The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol. 2014; 63(12):1123-1133. DOI: 10.1016/j.jacc.2013.11.053. View

20.

Adelstein E, Althouse A, Schwartzman D, Jain S, Soman P, Saba S . Scar burden, not intraventricular conduction delay pattern, is associated with outcomes in ischemic cardiomyopathy patients receiving cardiac resynchronization therapy. Heart Rhythm. 2018; 15(11):1664-1672. DOI: 10.1016/j.hrthm.2018.05.027. View

Utilization and Efficacy of Cardiac Resynchronization Therapy in Patients With Chronic Heart Failure - A Report From the CHART-2 Study

Utilization and Efficacy of Cardiac Resynchronization Therapy in Patients With Chronic Heart Failure　- A Report From the CHART-2 Study