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Practice Guideline
. 2020 Dec;22(12):2349-2369.
doi: 10.1002/ejhf.2046.

Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care: A joint position statement from the Heart Failure Association (HFA), European Heart Rhythm Association (EHRA), and European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology

Wilfried Mullens  1   2 , Angelo Auricchio  3 , Pieter Martens  1   2 , Klaus Witte  4 , Martin R Cowie  5 , Victoria Delgado  6 , Kenneth Dickstein  7 , Cecilia Linde  8 , Kevin Vernooy  9   10 , Francisco Leyva  11 , Johann Bauersachs  12 , Carsten W Israel  13 , Lars H Lund  14 , Erwan Donal  15 , Giuseppe Boriani  16 , Tiny Jaarsma  17   18 , Antonio Berruezo  19 , Vassil Traykov  20 , Zaheer Yousef  21 , Zbigniew Kalarus  22 , Jens Cosedis Nielsen  23 , Jan Steffel  24 , Panos Vardas  25 , Andrew Coats  26 , Petar Seferovic  27 , Thor Edvardsen  28 , Hein Heidbuchel  29 , Frank Ruschitzka  30 , Christophe Leclercq  15
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Practice Guideline

Optimized implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care: A joint position statement from the Heart Failure Association (HFA), European Heart Rhythm Association (EHRA), and European Association of Cardiovascular Imaging (EACVI) of the European Society of Cardiology

Wilfried Mullens et al. Eur J Heart Fail. 2020 Dec.
Free article

Abstract

Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and all-cause mortality. Nevertheless, up to two-thirds of eligible patients are not referred for CRT. Furthermore, post-implantation follow-up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three European Society of Cardiology Associations, Heart Failure Association (HFA), European Heart Rhythm Association (EHRA) and European Association of Cardiovascular Imaging (EACVI), focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post-procedural care by focusing on four actionable domains: (i) overcoming CRT under-utilization, (ii) better understanding of pre-implant characteristics, (iii) abandoning the term 'non-response' and replacing this by the concept of disease modification, and (iv) implementing a dedicated post-implant CRT care pathway.

Keywords: Cardiac resynchronization therapy; Care pathways; Disease management; Disease modification; Heart failure; Implementation; Outcome; Response; Utilization.

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