title: Factors associated with improvement in utilization of cardiac resynchronization therapy in eligible heart failure patients: findings from IMPROVE HF.
abstract: BACKGROUND
  There is a well-recognized gap between the number of patients in whom cardiac resynchronization therapy (CRT) is indicated based on current guidelines and its actual utilization. In the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) study, there was a significant increase in the use of CRT at 24 months in patients with heart failure (HF) in comparison to baseline. This study evaluated patient, physician, and practice factors associated with this increase in CRT utilization.
  
  
  METHODS
  Patients with reduced left ventricular ejection fraction and chronic HF who met the eligibility criteria for CRT at baseline and 24 months were analyzed. Multivariate analyses using patient, physician, and practice characteristics were performed to evaluate factors associated with increased CRT utilization at 24 months.
  
  
  RESULTS
  There were 440 patients eligible for CRT both at baseline and 24 months, with 217 (49.3%) treated at baseline and 374 (85%) treated at 24 months, leading to an absolute increase in use of CRT of 35.7%, P < 0.001. Although serum sodium and the absence of rales had modest associations, none of the patient, physician, or practice characteristics had any significant association with the extent of increase in CRT utilization. There was a significant reduction in the variation of CRT utilization across practice sites after the implementation of the performance improvement initiative.
  
  
  CONCLUSIONS
  The performance improvement initiative in IMPROVE HF was the most important factor associated with an increase in guideline-recommended CRT utilization. This improvement in CRT utilization and reduced practice variability was found across a variety of cardiology and multispecialty practice sites.
authors: University at Buffalo, Buffalo, New York, USA.
authors: Ashish
authors: A
authors: Shukla
authors: Anne B
authors: AB
authors: Curtis
authors: Mandeep R
authors: MR
authors: Mehra
authors: Nancy M
authors: NM
authors: Albert
authors: Mihai
authors: M
authors: Gheorghiade
authors: J Thomas
authors: JT
authors: Heywood
authors: Yang
authors: Y
authors: Liu
authors: Christopher M
authors: CM
authors: O'Connor
authors: Dwight
authors: D
authors: Reynolds
authors: Mary Norine
authors: MN
authors: Walsh
authors: Clyde W
authors: CW
authors: Yancy
authors: Gregg C
authors: GC
authors: Fonarow
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement; D012042:Registries; D016896:Treatment Outcome