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European Heart Journal Advance Access originally published online on August 16, 2005
European Heart Journal 2006 27(3):323-329; doi:10.1093/eurheartj/ehi446
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

How many patients with heart failure are eligible for cardiac resynchronization? Insights from two prospective cohorts

Finlay A. McAlister1,*, Jack V. Tu2,3, Alice Newman2, Douglas S. Lee2, Shane Kimber4, Bibiana Cujec4 and Paul W. Armstrong4

1The Division of General Internal Medicine, 2E3.24 Walter Mackenzie Health Sciences Centre, University of Alberta, 8440 112 Street, Edmonton, Alberta T6G 2R7, Canada
2The Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Canada
3The Division of General Internal Medicine, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Canada
4The Division of Cardiology, University of Alberta, Edmonton, Canada

Received 14 April 2005; revised 10 June 2005; accepted 13 July 2005; online publish-ahead-of-print 16 August 2005.

* Corresponding author. Tel: +1 780 407 1399; fax: +1 780 407 2680. E-mail address: finlay.mcalister{at}ualberta.ca

See page 251 for the editorial comment on this article (doi:10.1093/eurheartj/ehi678)

Aims To determine what proportion of patients with heart failure are eligible for cardiac resynchronization therapy (CRT).

Methods and results Eligibility criteria from the trials establishing the efficacy of CRT were applied to two prospective cohorts: the first enrolled patients with newly diagnosed heart failure discharged from 103 hospitals between April 1999 and March 2001 (‘the hospital discharge cohort’); the second enrolled patients seen in a specialized clinic between August 2003 and January 2004 (‘the specialty clinic cohort’). In the hospital discharge cohort, 73 patients (3% of the 2640 patients with ischaemic or dilated cardiomyopathy and 1% of all 9096 patients with heart failure discharged alive) met trial eligibility criteria: LVEF≤0.35, QRS ≥120 ms, sinus rhythm, and NYHA class III or IV symptoms despite the treatment with ACE-inhibitor/angiotensin receptor blocker and beta-blocker. In the specialty clinic cohort, 54 patients (21% of the 263 patients with ischaemic or dilated cardiomyopathy and 17% of all 309 patients with heart failure) met these criteria. If persistent symptoms despite taking spironolactone were required for CRT eligibility, then the proportions qualifying dropped to 1% in the hospital discharge cohort and 18% in the specialty clinic cohort.

Conclusion Few heart failure patients meet trial eligibily criteria for CRT.

Key Words: Heart failure • Cardiac resynchronization therapy • Eligibility


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