Heart failure & cardiomyopathies
Cardiac Resynchronization Therapy for Enabling Guideline-Directed Medical Therapy Optimization in Heart Failure
Authors' conclusion
In this large nationwide real-world population with HFrEF, CRT implantation was associated with enabled use/dose of heart failure GDMT and decreased loop diuretic need (use/dose).
Study context
- Population
- Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) in the Swedish Heart Failure Registry, January 2009–August 2022ITT analysis
- Participants
- 1,543 vs 4,537
- Exposure
- Cardiac resynchronization therapy (CRT) vs no CRT despite indication
- CRTn = 1,543
- Controlsn = 4,537reference
- Outcome
- Guideline-directed medical therapy (GDMT) optimization (improved use/dose) and loop diuretic use/dose
- Follow-up
- 1.5-year follow-up
Methodological detailsnationwide, intention-to-treat and per-protocol analyses
- Nationwide
- Intention-to-treat and per-protocol analyses
Main finding
As reported in the abstract
Improved beta-blocker use/dose; decreased loop diuretic use/dose
CRT
- Improved beta-blocker use/dose
- 46%
- Decreased loop diuretic use/dose
- 30%
Controls
- Improved beta-blocker use/dose
- 35%
- Decreased loop diuretic use/dose
- 24%
Improved beta-blocker use/dose
CRT46%
Controls35%
Decreased loop diuretic use/dose
CRT30%
Controls24%
CRT vs ControlsOdds ratio (95% CI)
Improved beta-blocker use/dose, adjusted
1.83(1.58–2.13)
Decreased loop diuretic use/dose, adjusted
1.26(1.07–1.48)
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| ACEi/ARB/ARNi and MRA optimization (per-protocol analysis)CRTvs ControlsACEi/ARB/ARNi optimization | 1.22 (1.04–1.44) | |
| ACEi/ARB/ARNi and MRA optimization (per-protocol analysis)CRTvs ControlsMRA optimization | 1.25 (1.05–1.50) | |
| 0.512Odds ratio (log scale) |
- Angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNi) and mineralocorticoid receptor antagonist (MRA) optimization (per-protocol analysis): per-protocol analysis (excluding controls who received a CRT during follow-up)
Original publication
Cardiac Resynchronization Therapy for Enabling Guideline-Directed Medical Therapy Optimization in Heart Failure. Eur J Heart Fail. Published 5 June 2025. doi:10.
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