© 2008 European Society of Cardiology
Successful treatment of heart failure with devices requires collaboration
a Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy University of Gothenburg, Göteborg, Sweden
b University of Hull, Cottingham England, United Kingdom
c National Heart and Lung Institute, Imperial College London, England, United Kingdom
d Helsinki University Hospital Helsinki, Finland
e University of Pavia, Fondazione Salvatore Maugeri Pavia, Italy
f Policlinico San Matteo Pavia, Italy
g University Medical Center Groningen Groningen, The Netherlands
h Clínica Puerta de Hierro Madrid, Spain
i St. George's Hospital Medical School London, England, United Kingdom
j Stavanger University Hospital Stavanger, Cardiology Division, University of Bergen, Norway
k Medizinische Hochschule Hannover Hannover, Germany
l Athens University Hospital ATTICON Athens, Greece
m Karolinska University Hospital Stockholm, Sweden
n Hospital Universitario la Paz Madrid, Spain
o San Filippo Neri Hospital Rome, Italy
p Hôpital Jeanne d'Arc Toul, France
* Corresponding author. Department of Medicine, Sahlgrenska University Hospital/Östra, SE-416 85 Göteborg, Sweden. Tel.: +46 313434078; fax: +46 31258933. E-mail address: karl.swedberg{at}gu.se (K. Swedberg).
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Abstract |
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Implanted biventricular pacemakers (cardiac resynchronisation therapy, CRT) with or without implantable cardioverter defibrillators (ICD) improve survival and morbidity in some patients with chronic heart failure (CHF) who are optimally treated with pharmacologic agents according to current guidelines. Correspondingly, ICDs improve survival.
However, there is only limited evidence for device treatment in certain patient subgroups, such as the impact of ICD on outcomes in patients with reduced ejection fraction in New York Heart Association (NYHA) Class I or IV heart failure. Similarly, limited evidence exists for CRT in patients with only modest QRS prolongation or only modestly reduced ejection fraction.
Despite evidence for a beneficial effect of device therapy in CHF, only a minority of eligible patients are currently offered these options. Multiple reasons contribute to the underuse of these potentially life-saving therapies. A lack of adherence to guidelines by health care professionals is an important barrier. Clearly, efforts should be made to improve the standard of care and to familiarise all physicians involved in managing CHF patients with the indications and potential efficacy of these devices. Increased collaboration between structured heart failure care and pacemaker clinics as well as between electrophysiologists, heart failure clinicians, and primary care physicians is required. Such team collaborations should lead to improved care with reduced mortality and morbidity and increased cost effectiveness. Treatment strategy should be based on a structured approach tailored to local practice and national priorities.
Key Words: Cardiac resynchronisation therapy • Chronic heart failure • Device • Defibrillator • Guidelines • Treatment
Received August 11, 2008; Accepted September 22, 2008
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