title: Utilization of defibrillators and resynchronization therapy at the time of evaluation at a heart failure and cardiac transplantation center.
abstract: BACKGROUND
  Internal cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce mortality, but are underutilized in routine clinical practice. The use of these devices in patients at the time of an initial evaluation at an advanced heart failure and cardiac transplantation center is unknown.
  
  
  METHODS
  We retrospectively analyzed consecutive patients who were enrolled in a database examining parameters of cardiopulmonary exercise testing in chronic heart failure (CHF) patients at the time of an initial outpatient evaluation at a tertiary care center. Rates of ICD and CRT use in eligible patients were determined.
  
  
  RESULTS
  Two hundred two patients had an average age of 54 +/- 13 years and an average peak oxygen consumption (pVO(2)) of 12.5 +/- 4.5 mL/kg/min. Of 97 patients eligible for an ICD only, 57% had an ICD at the time of evaluation. Sixty-four percent of ICD-eligible male patients had an ICD compared to 36% of ICD-eligible female patients (P = 0.015). Of 105 patients meeting criteria for CRT, 54% had a CRT device. There was no difference between CRT use in eligible male and female patients.
  
  
  CONCLUSIONS
  ICDs and CRT are underutilized in patients with severe CHF at the time of evaluation at a tertiary care center despite young age, objective functional limitation, and active consideration for advanced CHF therapies. Female patients have lower rates of ICD use than male patients.
authors.affiliation: Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York, USA. das9093@nyp.org
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Sims
authors.forename: Luis I
authors.initials: LI
authors.lastname: Garcia
authors.forename: Andrea
authors.initials: A
authors.lastname: Mignatti
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.forename: Margaret
authors.initials: M
authors.lastname: Jones
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.forename: Donna M
authors.initials: DM
authors.lastname: Mancini
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Jorde
mesh_terms: D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption