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.

Keywords: Cardiac resynchronization therapy; Defibrillator; Heart failure; Primary prevention.

Fig. 1

Study population enrolled for the comparative analysis of CRT-D and CRT-P recipients for primary prevention during the period from January 2011 to August 2015. CRT, cardiac resynchronization therapy (=biventricular pacing); CRT-D, CRT with implantable cardioverter-defibrillator; CRT-P, CRT pacemaker.

Fig. 2

Annual distribution of cardiac implantable electronic device implantations between 2006 and 2014 from the JCDTR database. (A) Distribution of CRT-D and CRT-P implantations. The yellow line indicates the percentage of CRT devices (CRT-D and CRT-P) among all the devices (including ICD/CRT-D/CRT-P). (B) Distribution of CRT-P and CRT-D implantations for primary and secondary prevention. The yellow line indicates the percentage of primary prevention among all the CRT-D recipients. CRT, cardiac resynchronization therapy (=biventricular pacing); CRT-D, CRT with implantable cardioverter-defibrillator; CRT-P, CRT pacemaker; ICD, implantable cardioverter-defibrillator.

Fig. 3

Proportion of CRT devices registered in the JCDTR by non-university (A) and university (B) hospitals. Among the study population (given in Fig. 1), 2160 patients and 1109 patients were enrolled from non-university hospitals and university hospitals, respectively. The proportion of CRT-P devices registered was 20.6% of patients from non-university hospitals and 9.9% of patients from university hospitals (P<0.0001). Conversely, the proportion of patients who had a CRT-D device for primary prevention was 79.4% in non-university hospitals and 90.1% in university hospitals.