title: Successful treatment of heart failure with devices requires collaboration.
abstract: 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.
authors.affiliation: Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. karl.swedberg@gu.se
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: John
authors.initials: J
authors.lastname: Cleland
authors.forename: Martin R
authors.initials: MR
authors.lastname: Cowie
authors.forename: Markku
authors.initials: M
authors.lastname: Nieminen
authors.forename: Silvia G
authors.initials: SG
authors.lastname: Priori
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Luis
authors.initials: L
authors.lastname: Alonso-Pulpon
authors.forename: John
authors.initials: J
authors.lastname: Camm
authors.forename: Kenneth
authors.initials: K
authors.lastname: Dickstein
authors.forename: Helmut
authors.initials: H
authors.lastname: Drexler
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: Cecilia
authors.initials: C
authors.lastname: Linde
authors.forename: José
authors.initials: J
authors.lastname: Lopez-Sendon
authors.forename: Massimo
authors.initials: M
authors.lastname: Santini
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
mesh_terms: D002304:Cardiac Pacing, Artificial; D002908:Chronic Disease; D003299:Cooperative Behavior; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D010138:Pacemaker, Artificial; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left