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Heart failure & cardiomyopathiesCohort study

Cardiac Resynchronization Therapy for Enabling Guideline-Directed Medical Therapy Optimization in Heart Failure

Eur J Heart FailPublished

  • Registry-based cohort study
  • nationwide
  • intention-to-treat and per-protocol analyses
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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

Main finding

As reported in the abstract

Improved beta-blocker use/dose; decreased loop diuretic use/dose

CRT

46%

Improved beta-blocker use/dose · Decreased loop diuretic use/dose 30%

Controls

35%

Improved beta-blocker use/dose · Decreased loop diuretic use/dose 24%

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

OutcomeOR (95% CI)
ACEi/ARB/ARNi and MRA optimization (per-protocol analysis) — CRT vs Controls · ACEi/ARB/ARNi optimization1.22 (1.04–1.44)
ACEi/ARB/ARNi and MRA optimization (per-protocol analysis) — CRT vs Controls · MRA optimization1.25 (1.05–1.50)
  • 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:10.1002/ejhf.3719
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Summarised from the published abstract; every number is checked against it