Guideline-directed device therapies in heart failure: A clinical practice-based analysis using electronic health record data

American Heart Journal Plus

Christopher Manrodt¹  Anne B. Curtis²  Gregg C. Fonarow³  Luke D. Jacobsen³  Dana Soderlund³ 

[1] Corresponding author at: University of Buffalo, 100 High Street, D2-76, Buffalo, NY 14203, United States of America.;Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America;Medtronic, Inc., Mounds View, MS, United States of America;

关键词: Guideline-directed device therapy;    Implantable cardioverter defibrillator;    Cardiac resynchronization therapy;    Electronic health record;    Heart failure;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Guideline-directed device therapies (GDDT) improve outcomes for eligible patients with heart failure (HF) with reduced ejection fraction (HFrEF). Utilization rates of device therapies in HFrEF after the 2012 ACCF/AHA/HRS Focused Update for Device-based Therapies of Cardiac Rhythm Abnormalities have not been well studied. Objective: Characterize the use of GDDT in newly indicated HFrEF patients from 2012 to 2019 using aggregated electronic health record (EHR) data. Methods: Computable phenotyping algorithms for implantable cardioverter defibrillator/cardiac resynchronization therapy-defibrillator (ICD/CRT-D) indications from the GuideLine Indications Detected in EHR for Heart Failure program (GLIDE-HF) used diagnoses, procedures, measures, prescriptions, and the output of natural language processed provider notes from de-identified Optum® EHR data. Patients had a diagnosis of HF, dilated cardiomyopathy, or prior infarct, and were included if they had HFrEF with >1 year of records prior to a new Class 1 or Class 2a indication for an ICD or cardiac resynchronization therapy with defibrillator (CRT-D) from 2012 to 2019. Results: Records showed 137,476 HFrEF patients were newly indicated for an ICD or CRT-D. GDDT was used in 14,892 of 36,358 (41.0%) CRT-D indicated patients and in 14,904 of 101,118 (14.7%) ICD-indicated patients. While GDDT use was low, 95.7% had echocardiography and 92.1% had prescriptions for beta-blockers or angiotensin-converting enzyme/angiotensin-receptor blockers medications. Conclusions: In this modern cohort of HF patients, a large proportion of eligible patients did not receive ICDs or CRT-Ds, while frequently receiving other indicated cardiovascular interventions and treatments.

【 授权许可】

Unknown