title: Trends and determinant factors in the use of cardiac resynchronization therapy devices in Japan: Analysis of the Japan cardiac device treatment registry database.
abstract: BACKGROUND
  The choice of cardiac resynchronization therapy device, with (CRT-D) or without (CRT-P) a defibrillator, in patients with heart failure largely depends on the physician׳s discretion, because it has not been established which subjects benefit most from a defibrillator.
  
  
  METHODS
  We examined the annual trend of CRT device implantations between 2006 and 2014, and evaluated the factors related to the device selection (CRT-D or CRT-P) for primary prevention of sudden cardiac death in patients with heart failure by analyzing the Japan Cardiac Device Treatment Registry (JCDTR) database from January 2011 and August 2015 (CRT-D,n=2714; CRT-P,n=555).
  
  
  RESULTS
  The proportion of CRT-D implantations for primary prevention among all the CRT-D recipients was more than 70% during the study period. The number of CRT-D implantations for primary prevention reached a maximum in 2011 and decreased gradually between 2011 and 2014, whereas CRT-P implantations increased year by year until 2011 and remained unchanged in recent years. Multivariate analysis identified age (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.90-0.95,P<0.0001), male sex (OR 1.99, 95% CI 1.28-3.11,P<0.005), reduced left ventricular ejection fraction (LVEF) (OR 0.96, 95% CI 0.94-0.98,P<0.0001), and non-sustained ventricular tachycardia (NSVT) (OR 2.85, 95% CI 1.87-4.35,P<0.0001) as independent factors favoring the choice of CRT-D.
  
  
  CONCLUSIONS
  Younger age, male sex, reduced LVEF, and a history of NSVT were independently associated with the choice of CRT-D for primary prevention of sudden cardiac death in patients with heart failure in Japan.
authors.affiliation: Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yokoshiki
authors.affiliation: Faculty of Health Sciences, Yamaguchi Graduate School of Medicine, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Shimizu
authors.affiliation: Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Mitsuhashi
authors.affiliation: Furushima Clinic, Niigata, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furushima
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sekiguchi
authors.affiliation: Asakusa Heart Clinic, Tokyo, Japan.
authors.forename: Tetsuyuki
authors.initials: T
authors.lastname: Manaka
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Nishii
authors.affiliation: Division of Cardiology, Department of Medicine and Clinical Sciences, Yamaguchi Graduate School of Medicine, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ueyama
authors.affiliation: Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital, Japan.
authors.forename: Norishige
authors.initials: N
authors.lastname: Morita
authors.affiliation: Cardiovascular Surgery, Nippon Medical School, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nitta
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
keywords: Cardiac resynchronization therapy; Defibrillator; Heart failure; Primary prevention