Prescription of Guideline-Recommended Implantable Cardioverter Defibrillator and Cardiac Resynchronization Therapy Among Patients Hospitalized With Heart Failure and Varying Degrees of Renal Function.
Implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) reduce mortality in many patients with heart failure (HF), but the current use and effectiveness of ICD/CRT in patients with chronic kidney disease (CKD) are uncertain. We examined associations between kidney function and guideline-recommended prescription of ICD/CRT in the Get With The Guidelines-Heart Failure registry, a performance improvement program for hospitalized patients with HF. We compared differences in ICD and CRT prescription between the following categories of estimated glomerular filtration rate (eGFR; mL/min/1.73 m2): ≥60, 59 to 30, <30, and dialysis dependent. From 2008 through 2014, 26,286 patients were eligible for ICD or CRT, and 16,123(61%) had an eGFR <60. De novo ICD and CRT prescription in this group was low at 45% and 30.5%, respectively. Compared to patients with eGFR ≥60, patients with eGFR 30 to 59 were more likely to receive an ICD (adjusted odds ratio [aOR] 1.08, 95% confidence intervals [CI] 1.01 to 1.14), whereas dialysis patients were less likely (aOR 0.61, 95% CI 0.5 to 0.76). Worse kidney function was associated with a decreased likelihood of CRT prescription (aOR 0.97 per 10 ml/min eGFR decrease, p = 0.03). During the study period, the likelihood of both ICD and CRT prescription increased over time among patients with CKD (ICD aOR 1.12, 95% CI 1.07 to 1.18; CRT aOR 1.14, 95% CI 1.06 to 1.23, per year). Prescription of an ICT/CRT was associated with greater 1-year survival in all eGFR groups. In conclusion, there are significant CKD-based differences in prescription of ICD and CRT in HF. However, given the current state of evidence, it is unclear whether improved prescription of ICD and CRT in the CKD population will result in improvement in outcomes.
Duke Clinical Research Institute, Durham, North Carolina; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina. Electronic address: Patrick.Pun@dm.duke.edu.
Patrick H
PH
Pun
Duke Clinical Research Institute, Durham, North Carolina.
Shubin
S
Sheng
Duke Clinical Research Institute, Durham, North Carolina.
Gillian
G
Sanders
Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Adam D
AD
DeVore
Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Daniel
D
Friedman
Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, California.
Gregg C
GC
Fonarow
Veterans Administration Palo Alto Health Care System, Palo Alto, California.
Paul A
PA
Heidenreich
Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
Clyde W
CW
Yancy
Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Adrian F
AF
Hernandez
Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
Sana M
SM
Al-Khatib
D000368:Aged; D015415:Biomarkers / Q000097:blood; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017147:Defibrillators, Implantable; D003710:Demography; D004554:Electric Countershock; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome; D014481:United States
D015415:Biomarkers