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European Heart Journal Advance Access published online on August 16, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi446
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received April 14, 2005
Revised June 10, 2005
Accepted July 13, 2005

Clinical research

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

Finlay A. McAlister 1*, Jack V. Tu 2, Alice Newman 3, Douglas S. Lee 3, Shane Kimber 4, Bibiana Cujec 4, and Paul W. Armstrong 4

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

* To whom correspondence should be addressed.
Finlay A. McAlister, E-mail: finlay.mcalister{at}ualberta.ca


  Abstract

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.

Keywords: Heart failure; Cardiac resynchronization therapy; Eligibility.
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