B-AB23-01 TEMPORAL TRENDS AND OUTCOMES AMONG CARDIAC RESYNCHRONIZATION THERAPY RECIPIENTS IN THE UNITED STATES, 2011-2015: INSIGHTS FROM THE NATIONAL CARDIOVASCULAR DATA REGISTRY

Abstract

Long-term outcomes of cardiac resynchronization (CRT) recipients have not been examined since the inception of updated device guidelines in 2012. To evaluate annual trends of rates of implantation based on guideline recommendations, rates of optimal medical therapy and long-term outcomes among Medicare beneficiaries undergoing CRT-D between 2011-2015. Using the National Cardiovascular Data Registry ICD Registry, we identified Medicare beneficiaries aged ≥ 65 years who underwent an initial CRT-D implantation between 2011 and 2015. The trends of unadjusted outcomes including device indications, optimal medical therapy (beta blocker and ACE inhibitor or ARB at discharge), in-hospital complications and long-term outcomes were calculated using the Cochran-Armitage test. A total of 53,174 patients undergoing initial CRT-D implantation with linked Medicare data were included in the study cohort. The mean (SD) age 75.4 (±6.4) years and 15,823 (29.8%) were women. There was an increase in the rates of implant in those with NYHA class II symptoms, LBBB and QRS ≥ 150 ms (14.4% in 2011 to 20.7% in 2015, P<0.001), while there was a decrease in those with NYHA III symptoms (82.7% to 76.7%, P<0.001). Optimal medical therapy increased (68.1% to 70.6%, P<0.001) and in-hospital complications decreased. Over a 2-year follow-up, all-cause, cardiovascular, and heart failure readmissions also decreased. In a large contemporary population of Medicare beneficiaries undergoing CRT-D implantation between 2011-2015, there was an increase in optimal medical therapy and reduction in long-term adverse outcomes at 2-year follow-up.