Optimization of medical treatment improve long term survival of heart failure patients after ICD and CRT implantation. Insight from National French Database

Abstract

Rognosis of heart failure with reduced ejection fraction (HFREF) is improved by tailored drugs optimization but poor is known concerning such optimization in HFREF patients implanted by implantable cardiac defibrillator (ICD) or cardiac resynchronization therapy (CRT). We conduct an evaluation of European guidelines implement before device implantation. Between January 2009 and December 2014, data were extracted from the échantillon généraliste des bénéficiaires (EGB) database, a representative 1/97 random sample of the population covered by the French national health insurance system. We included HFREF patients implanted by ICD or CRT. Survival and treatments were analyzed at baseline, 3 months and until January 2016. We included a sample of 378 patients (135 CRT, 243 ICD) with a mean age of 68 ± 13 years old. Mean follow-up was 23 months (11–42). At baseline, 36% of patients had only one or no HF drug among beta-blocker (BB), angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blockers (ARB) and mineralocorticoid receptor antagonist (MRA). Twenty-six percent had an optimal treatment (all the 3 classes). At 3 months, prescription rate was higher compared to baseline but not at the end of follow-up. HF hospitalization rate was higher in non-optimized patient group 28% vs. 14% ( P = 0.001). HFrEF optimal treatment was associated with a better survival (HR = 0.27 [0.15–0.46], P < 0.001) ( Fig. 1 ). HFREF drugs are under prescribed before CRT and ICD implantations despite we demonstrated that treatment optimization reduced HF hospitalization.