title: Prevalence of guideline-directed medical therapy among patients receiving cardiac resynchronization therapy defibrillator implantation in the National Cardiovascular Data Registry during the years 2006 to 2008.
abstract: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality among selected patients with left ventricular systolic dysfunction and severe heart failure symptoms despite guideline-directed medical therapy (GDMT). Contemporaneous guidelines provided clear recommendations regarding selection of patients for CRT, including that all patients should first receive GDMT with β blockers and renin-angiotensin axis antagonists. Prevalence of GDMT among real-world patients receiving CRT defibrillators (CRT-D) has not been well studied. We identified 45,392 patients in the National Cardiovascular Data Registry Implantable Cardioverter-Defibrillator Registry who underwent first CRT-D implantation for primary prevention of sudden death from January 2006 to June 2008. We calculated the proportion of patients with contemporaneous class I guideline indications for CRT-D, the proportion receiving GDMT for heart failure, and the proportion receiving GDMT who had class I guideline indications for CRT-D. Among patients without contraindications, 87% were prescribed β blockers, 78% an angiotensin-converting enzyme inhibitor or an angiotensin II receptor inhibitor, and 70% both a β blocker and an angiotensin-converting enzyme or angiotensin II receptor inhibitor at discharge. Finally, 50% of patients met class I guideline indications and were prescribed GDMT at discharge; 9% neither met class I indications nor were prescribed GDMT at discharge. The major limitation of this study is the lack of dosage information in the Implantable Cardioverter-Defibrillator Registry and lack of prescribing information at times other than discharge. In conclusion, many patients receiving CRT-D are not receiving GDMT at discharge. Ensuring that all patients receiving CRT-D are also receiving GDMT appears to be a quality improvement target.
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado. Electronic address: Preston.Schneider@ucdenver.edu.
authors.forename: Preston M
authors.initials: PM
authors.lastname: Schneider
authors.affiliation: Cardiac Electrophysiology Section, University of California, San Francisco, Section of Cardiology, San Francisco Veterans Administration Medical Center, San Francisco, California; Division of Cardiology, Department of Medicine, University of California, San Francisco, Section of Cardiology, San Francisco Veterans Administration Medical Center, San Francisco, California.
authors.forename: Cara N
authors.initials: CN
authors.lastname: Pellegrini
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Fein
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
authors.affiliation: Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, Colorado; Kaiser Permanente Colorado Institute of Health Research and Denver Health Medical Center, Denver, Colorado.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, Colorado; Division of Cardiology, Veterans Administration Eastern Colorado Healthcare System, Denver, Colorado.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Varosy
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors