Cardiac Resynchronization Therapy (CRT): Patient Selection and Guideline Adherence : An Analysis of CRT Practice in Europe Based on the European Society of Cardiology CRT Survey II with 11088 patients in 42 countries.

Background/Aims Cardiac Resynchronization Therapy (CRT) reduces morbidity and mortality in patients with heart failure and electrical dyssynchrony. Recommendations for which patients should receive a CRT device are outlined in cardiology society guidelines. However, these recommendations vary and for certain recommendations are imprecise. The purpose of this PhD is to explore why there are variations in international guideline recommendations and how these may contribute to differences in practice using the cohort of CRT Survey II with 11 088 patients in 42 European Society of Cardiology (ESC) member countries. Methods The recommendations provided by the major international guidelines were reviewed to identify areas of consistency and inconsistency in CRT recommendations. Data were collected on consecutive patients implanted with a CRT device in 42 ESC countries. These data were analysed to assess CRT practice and guideline adherence and relate them to variations in guideline recommendations. Results There was mainly consistency in the international guidelines regarding who should receive a device. However, some inconsistencies were identified. These included patients with non-left bundle branch block (LBBB) and patients with heart failure and a pacemaker requirement, implanted with a CRT to avoid right ventricular pacing dependence. Some of these inconsistencies could be explained by the timing of the release of the guidelines. However, others appeared to be related to CRT trial evidence being interpreted differently by different societies. In the European CRT population we found that implanters adhered well to European guidelines with only 2% of patients being implanted outside guideline recommendations. However, practice did vary in the different countries and these variations were more pronounced in areas where guideline recommendations are inconsistent or undetermined. Discussion Adherence to guidelines for CRT in Europe is high. However, in areas where there is limited CRT trial evidence this results in imprecise and inconsistent recommendations in international guidelines and may contribute to promoting variations in CRT practices in different countries

Upgrades from Previous Cardiac Implantable Electronic Devices Compared to De Novo Cardiac Resynchronization Therapy Implantations: Results from CRT Survey-II in the Turkish Population

Objective: Cardiac resynchronization therapy is the guideline-directed treatment option in selected heart failure with reduced left ventricular ejection fraction patients. Data regarding the contemporary clinical practice of cardiac resynchronization therapy in Turkey have been published recently. This sub-study aims to compare clinical and periprocedural characteristics between cardiac resynchronization therapy upgrade and de novo implantations. Methods: Turkish arm of the Cardiac Resynchronization Therapy Survey-II was conducted between October 1, 2015, and December 31, 2016, at 16 centers. All consecutive patients who underwent an upgrade to cardiac resynchronization therapy system (n=60) or de novo cardiac resynchronization therapy implantation (n=335) were eligible. Results: Distribution of age, gender, and heart failure etiology were similar in the 2 groups. Atrial fibrillation, valvular heart disease, and chronic kidney disease were more common in cardiac resynchronization therapy upgrade patients. Narrow intrinsic QRS duration and left ventricular ejection fraction being 75% in both groups, and only beta-blockers were prescribed at rates of >90% in both groups. Conclusion: Cardiac resynchronization therapy upgrades are performed with high procedural success rates and without excess periprocedural complication risk. Feared complications of cardiac resynchronization therapy upgrades due to the pre-existing device should not delay the procedure if indicated.publishedVersio

Second European Cardiac Resynchronisation Therapy Survey (Crt Survey II): Latvian Data Compared to Europe

The cardiac resynchronisation therapy (CRT) survey II is a joint initiative between the European Heart Rhythm Association and the Heart Failure Association. It compiles real world data about cardiac resynchronisation therapy in European Society of Cardiology member states. 11 088 patients assigned to implantation of CRT with pacemaker function (CRT-P) or CRT with an incorporated defibrillator (CRT-D) were enrolled in the survey starting 1 October 2015 till 31 December 2016 and for each patient, an electronic case report form (eCRF) was completed. Each participating country had each eCRF data-point benchmarked against the total cohort. In total, 79 patients were included from Latvia. The mean age of patients was 68.1, similar to the total cohort of other ESC member states, and 21.8% of patients were female. Latvian patients compared to other countries more often had permanent atrial fibrillation, NYHA class III and IV, ejection fraction 35 %. CRT-Ds and multipolar lead implantation rates were higher. Peri-procedural complication rates were similarly low in both groups. At discharge, prescribed medication rates were similar but more frequently MRAs, ivabradine and calcium channel blockers were prescribed and slightly less frequently ACE inhibitors/ARBs were prescribed. The CRT survey II is a valuable resource that describes ongoing practice of cardiac resynchronisation therapy around Europe and benchmarking against the total cohort is nationally significant for each participating country.publishersversionPeer reviewe

European Cardiac Resynchronization Therapy Survey II: rationale and design

The Cardiac Resynchronization Therapy (CRT) Survey II is a 6 months snapshot survey initiated by two ESC Associations, the European Heart Rhythm Association and the Heart Failure Association, which is designed to describe clinical practice regarding implantation of CRT devices in a broad sample of hospitals in 47 ESC member countries. The large volume of clinical and demographic data collected should reflect current patient selection, implantation, and follow-up practice and provide information relevant for assessing healthcare resource utilization in connection with CRT. The findings of this survey should permit representative benchmarking both nationally and internationally across Europ

European Cardiac Resynchronization Therapy Survey II: rationale and design

The Cardiac Resynchronization Therapy (CRT) Survey II is a 6 months snapshot survey initiated by two ESC Associations, the European Heart Rhythm Association and the Heart Failure Association, which is designed to describe clinical practice regarding implantation of CRT devices in a broad sample of hospitals in 47 ESC member countries. The large volume of clinical and demographic data collected should reflect current patient selection, implantation, and follow-up practice and provide information relevant for assessing healthcare resource utilization in connection with CRT. The findings of this survey should permit representative benchmarking both nationally and internationally across Europ

Croatian National Data and Comparison with European Practice: Data from the Cardiac Resynchronization Therapy Survey II Multicenter Registry

. The Cardiac Resynchronization Therapy (CRT) Survey II was conducted between October 2015 and December 2016 and included data from 11088 CRT implantations from 42 countries. The survey’s aim was to report on current European CRT practice. The aim of this study was to compare the Croatian national CRT practice with the European data. . Five centres from Croatia recruited consecutive patients, in a 15-month period, who underwent CRT implantation, primary or an upgrade. Data were collected prospectively by using online database. . A total of 115 patients were included in Croatia, which is 33.2% of all CRT implants in Croatia during the study period (total ). Median age of the study population was 67 (61–73) years, and 21.2% were women. Primary heart failure (HF) aetiology was nonischemic in 61.1% of patients, and HF with wide QRS was the most common indication for the implantation (73.5%). 80% of patients had complete left bundle branch block, and over two-third had QRS ≥150 ms. Device-related adverse events were recorded in 4.3% of patients. When compared with European countries, Croatian patients were significantly younger (67 vs. 70 years, ), had similar rate of comorbidities with the exception of higher prevalence of hypertension. Croatian patients significantly more often received CRT-pacemaker when compared with European population (58.3 vs. 29.9%, OR 3.27, 95%CI 2.25–4.74, ). . Our data indicate strict selection of patients among HF population and adherence to guidelines with exception of higher proportion of CRT-pacemaker implantation. This is likely to be influenced by healthcare organization and reimbursement issues in Croatia

CRT Survey II: a European Society of Cardiology survey of cardiac resynchronisation therapy in 11 088 patients—who is doing what to whom and how?

Background: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008–2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT. Methods and results: A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed. Conclusion: CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy

Do we differ in terms of indications and demographics in cardiac resynchronisation recipients in Poland? Insights from the European CRT Survey II Registry

Background: Multiple randomised clinical trials have proven that cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with congestive heart failure and is recommended for such patients as per the European Society of Cardiology guidelines. Aims: In this paper we compare the indications and demographics in cardiac resynchronisation recipients in Poland and other European countries. Methods: In 2015 and 2016, physicians from 42 European countries participated in the second edition of the European Cardiac Resynchronisation Therapy Survey. For 14 months, 288 implanting centres gathered data regarding demography, indications, implanting methods, and guidance compatibility from 11,088 patients receiving CRT. Results: The survey revealed that a vast group of patients were eligible for CRT implantation (although some of them with rela­tively weak guidance recommendations) and showed essential variety in clinical practice when national data were benchmarked. Conclusions: The population of CRT recipients in Poland and other European countries did not differ in terms of demographic and clinical characteristics. In most cases, indications for CRT were in accordance with the guidelines; however some devices were implanted in patients beyond the guideline recommendations. For these procedures, the decision regarding CRT im­plantation relies mainly on the physicians’ experience

<scp>ReSurveyEurope</scp>: A database of resurveyed vegetation plots in Europe

AbstractAimsWe introduce ReSurveyEurope — a new data source of resurveyed vegetation plots in Europe, compiled by a collaborative network of vegetation scientists. We describe the scope of this initiative, provide an overview of currently available data, governance, data contribution rules, and accessibility. In addition, we outline further steps, including potential research questions.ResultsReSurveyEurope includes resurveyed vegetation plots from all habitats. Version 1.0 of ReSurveyEurope contains 283,135 observations (i.e., individual surveys of each plot) from 79,190 plots sampled in 449 independent resurvey projects. Of these, 62,139 (78%) are permanent plots, that is, marked in situ, or located with GPS, which allow for high spatial accuracy in resurvey. The remaining 17,051 (22%) plots are from studies in which plots from the initial survey could not be exactly relocated. Four data sets, which together account for 28,470 (36%) plots, provide only presence/absence information on plant species, while the remaining 50,720 (64%) plots contain abundance information (e.g., percentage cover or cover–abundance classes such as variants of the Braun‐Blanquet scale). The oldest plots were sampled in 1911 in the Swiss Alps, while most plots were sampled between 1950 and 2020.ConclusionsReSurveyEurope is a new resource to address a wide range of research questions on fine‐scale changes in European vegetation. The initiative is devoted to an inclusive and transparent governance and data usage approach, based on slightly adapted rules of the well‐established European Vegetation Archive (EVA). ReSurveyEurope data are ready for use, and proposals for analyses of the data set can be submitted at any time to the coordinators. Still, further data contributions are highly welcome.</jats:sec

Cardiac Resynchronization Therapy (CRT): Patient Selection and Guideline Adherence : An Analysis of CRT Practice in Europe Based on the European Society of Cardiology CRT Survey II with 11088 patients in 42 countries.

Background/Aims Cardiac Resynchronization Therapy (CRT) reduces morbidity and mortality in patients with heart failure and electrical dyssynchrony. Recommendations for which patients should receive a CRT device are outlined in cardiology society guidelines. However, these recommendations vary and for certain recommendations are imprecise. The purpose of this PhD is to explore why there are variations in international guideline recommendations and how these may contribute to differences in practice using the cohort of CRT Survey II with 11 088 patients in 42 European Society of Cardiology (ESC) member countries. Methods The recommendations provided by the major international guidelines were reviewed to identify areas of consistency and inconsistency in CRT recommendations. Data were collected on consecutive patients implanted with a CRT device in 42 ESC countries. These data were analysed to assess CRT practice and guideline adherence and relate them to variations in guideline recommendations. Results There was mainly consistency in the international guidelines regarding who should receive a device. However, some inconsistencies were identified. These included patients with non-left bundle branch block (LBBB) and patients with heart failure and a pacemaker requirement, implanted with a CRT to avoid right ventricular pacing dependence. Some of these inconsistencies could be explained by the timing of the release of the guidelines. However, others appeared to be related to CRT trial evidence being interpreted differently by different societies. In the European CRT population we found that implanters adhered well to European guidelines with only 2% of patients being implanted outside guideline recommendations. However, practice did vary in the different countries and these variations were more pronounced in areas where guideline recommendations are inconsistent or undetermined. Discussion Adherence to guidelines for CRT in Europe is high. However, in areas where there is limited CRT trial evidence this results in imprecise and inconsistent recommendations in international guidelines and may contribute to promoting variations in CRT practices in different countries