Optimized Implementation of Cardiac Resynchronization Therapy: A Call for Action for Referral and Optimization of Care
European Journal of Heart Failure, vol. 22, pp. 2349–2369
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.
Authors 29
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Wilfried Müllens corresponding
Ziekenhuis Oost-Limburg · Hasselt University
Affiliation as printed
University Hasselt , Hasselt ,
Ziekenhuis Oost Limburg , Genk ,
University Hasselt, Hasselt, Belgium
Ziekenhuis Oost Limburg, Genk, Belgium
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Affiliation as printed
Division of Cardiology, Cardiocentro Ticino , Lugano ,
Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
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Ziekenhuis Oost-Limburg · Hasselt University
Affiliation as printed
University Hasselt , Hasselt ,
Ziekenhuis Oost Limburg , Genk ,
University Hasselt, Hasselt, Belgium
Ziekenhuis Oost Limburg, Genk, Belgium
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Affiliation as printed
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds , Leeds ,
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Royal Brompton Hospital · Imperial College London
Affiliation as printed
Imperial College London (Royal Brompton Hospital) , London ,
Imperial College London (Royal Brompton Hospital), London, UK
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Leiden University Medical Center
Affiliation as printed
Department of Cardiology, Leiden University Medical Center , Leiden ,
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Stavanger University Hospital · University of Bergen
Affiliation as printed
University of Bergen, Stavanger University Hospital , Bergen ,
University of Bergen, Stavanger University Hospital, Bergen, Norway
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Karolinska University Hospital · Karolinska Institutet
Affiliation as printed
Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet , Stockholm ,
Heart and Vascular Theme, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Radboud University Nijmegen · Maastricht University Medical Centre · Radboud University Medical Center · Maastricht University
Affiliation as printed
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center , Maastricht ,
Department of Cardiology, Radboud University Medical Center (Radboudumc) , Nijmegen ,
Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
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Affiliation as printed
Aston Medical School , Birmingham ,
Aston Medical School, Birmingham, UK
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Medizinische Hochschule Hannover
Affiliation as printed
Department of Cardiology and Angiology, Hannover Medical School , Hannover ,
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Affiliation as printed
Department of Medicine – Cardiology, Diabetology and Nephrology, Bethel-Clinic , Bielefeld ,
Department of Medicine – Cardiology, Diabetology and Nephrology Bethel‐Clinic Bielefeld Germany
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Karolinska University Hospital · Karolinska Institutet
Affiliation as printed
Department of Medicine Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital , Stockholm ,
Department of Medicine Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
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Inserm · Laboratoire Traitement du Signal et de l'Image · Centre Hospitalier Universitaire de Rennes · Université Rennes 1 · Université de Rennes
Affiliation as printed
Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1 , Rennes ,
Cardiologie, CHU Rennes ‐ LTSI Inserm UMR 1099, Université Rennes‐1 Rennes France
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University of Modena and Reggio Emilia
Affiliation as printed
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena ,
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Linköping University · Utrecht University · University Medical Center Utrecht
Affiliation as printed
Department of Health, Medicine and Caring Science, Linköping University , Linköping ,
Julius Center, University Medical Center Utrecht , Utrecht ,
Department of Health, Medicine and Caring Science Linköping University Linköping Sweden
Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Affiliation as printed
Heart Institute, Teknon Medical Center , Barcelona ,
Heart Institute, Teknon Medical Center, Barcelona, Spain
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Tokuda Hospital · Acibadem City Clinic
Affiliation as printed
Department of Cardiology, Acibadem City Clinic Tokuda Hospital , Sofia ,
Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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University Hospital of Wales · Cardiff University
Affiliation as printed
Department of Cardiology, University Hospital of Wales & Cardiff University , Cardiff ,
Department of Cardiology University Hospital of Wales & Cardiff University Cardiff UK
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Affiliation as printed
Department of Cardiology, Medical University of Silesia , Katowice ,
Department of Cardiology, Medical University of Silesia, Katowice, Poland
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Affiliation as printed
Department of Cardiology, Aarhus University Hospital , Aarhus ,
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Affiliation as printed
UniversitätsSpital Zürich , Zürich ,
UniversitätsSpital Zürich Zürich Switzerland
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Affiliation as printed
Heart Sector, Hygeia Hospitals Group , Athens ,
Heart Sector, Hygeia Hospitals Group, Athens, Greece
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Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele
Affiliation as printed
IRCCS San Raffaele Pisana , Rome ,
IRCCS San Raffaele Pisana, Rome, Italy
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Serbian Academy of Sciences and Arts · University of Belgrade
Affiliation as printed
Faculty of Medicine, Serbian Academy of Science and Arts, Belgrade University , Belgrade ,
Faculty of Medicine, Serbian Academy of Science and Arts, Belgrade University, Belgrade, Serbia
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Oslo University Hospital · University of Oslo
Affiliation as printed
Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo , Oslo ,
Department of Cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway
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Affiliation as printed
Antwerp University and Antwerp University Hospital , Antwerp ,
Antwerp University and Antwerp University Hospital, Antwerp, Belgium
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Affiliation as printed
Department of Cardiology, University Hospital, University Heart Center , Zurich ,
Department of Cardiology, University Hospital, University Heart Center, Zurich, Switzerland
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Inserm · Laboratoire Traitement du Signal et de l'Image · Centre Hospitalier Universitaire de Rennes · Université Rennes 1 · Université de Rennes
Affiliation as printed
Cardiologie, CHU Rennes - LTSI Inserm UMR 1099, Université Rennes-1 , Rennes ,
Cardiologie, CHU Rennes ‐ LTSI Inserm UMR 1099, Université Rennes‐1 Rennes France
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