Evaluation of potential underuse of cardiac resynchronization therapy for heart failure with reduced ejection fraction

BACKGROUND: The number of patients with chronic heart failure is increasing in Japan. However, the annual number of patients with heart failure who receive cardiac resynchronization therapy (CRT) has been constant in the last few years. In this study, we evaluated patients who did not receive CRT despite being eligible for this treatment to elucidate the clinical impact of CRT administration. METHODS: We assessed 214 patients with a left ventricular ejection fraction (LVEF) ≤ 50% (excluding patients treated with CRT) who underwent transthoracic echocardiography between January and May 2020 at our institution. The patients were stratified into two groups: Group A (n = 26; patients eligible for CRT) and Group B (n = 188; patients ineligible for CRT); however, all patients only received pharmacological therapy. We retrospectively analyzed the prognosis of these patients with respect to the cumulative number of hospitalizations for heart failure and cardiogenic deaths. RESULTS: We observed no significant between‐group differences in age, sex, and severity/diagnosis of organic heart disease. Group A had a significantly higher number of hospitalizations for heart failure and cardiogenic deaths than Group B (log‐rank test, P < .01; hazard ratio, 3.05; 95% confidence interval, 1.31‐7.09; average follow‐up period, 675 days). CONCLUSIONS: This study shows that 12% of patients were eligible for CRT. However, the implantation rate was low and no one was implanted. CRT is underutilized in patients who have heart failure with reduced LVEF. Therefore, we strongly recommend CRT for patients with indications for CRT.