Outcomes/Effectiveness Research

Use of a new heart failure therapy that resynchronizes contraction of ventricles varies

A new study finds that use of cardiac resynchronization therapy (CRT), a treatment recommended for many patients hospitalized for congestive heart failure (CHF), varies. Patients with CHF commonly suffer from lack of coordinated contraction of their right and left ventricles. Such coordination is needed for proper movement of blood to the body, including the lungs. An implantable CRT device, much like a cardiac pacemaker, restores the coordination by stimulating both ventricles at the same time, as well as restoring the proper rhythm to the contraction of the right atrium and right ventricle.

The study finds that the use of this treatment varies depending on the patients' race, what part of the country they live in, other health problems, and their age. Further studies and the use of quality-of-care initiatives may help address these gaps in treatment, the researchers conclude.

The study analyzed data on 33,888 patients with CHF who were admitted over a 2-year period to 228 hospitals participating in an American Heart Association program to improve the treatment of this condition. The researchers found that 12 percent of these patients were discharged with CRT. The CRT patients were older than CHF patients not given CRT (70 percent of the CRT patients were Medicare beneficiaries), more likely to be white than black or of other races, had higher rates of kidney problems, and more than half had restricted blood flow to the heart muscle (ischemic cardiomyopathy).

The likelihood of a patient receiving a new CRT implant was lower for patients living in the northeastern States, of black race, and older than 70 years. In contrast to studies of patients receiving another kind of cardiovascular device (implantable cardioverter-defibrillators), black women and black men were equally likely to receive new CRT devices. The study was funded in part by the Agency for Healthcare Research and Quality (HS16964).

More details are in "Use of cardiac resynchronization therapy in patients hospitalized with heart failure," by Jonathan P. Piccini, M.D., Adrian F. Hernandez, M.D., M.H.S., David Dai, Ph.D., M.S., and others in the August 26, 2008, issue of Circulation 118, pp. 926-933.

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