Researchers at the Duke Clinical Research Institute (DCRI) have determined that race, age and geography appear to be significant factors in who receives cardiac resynchronization therapy (CRT), a proven treatment for some patients with heart failure. The study was funded by the American Heart Association and appears in the journal Circulation.

Dr. Jonathan Piccini, M.D., a cardiologist at Duke University Medical Center and the lead author of the study said, "We looked at figures nationwide, and we found that use of the therapy was extremely variable." According to Dr. Piccini, "Basically, a lot of people who should be getting the therapy aren't, and some of the people who are getting it may not need it."

Cardiac resynchronization utilizes a specialized pacemaker in the upper part of the chest and running leads into the heart which correct an electrical conduction problem, allowing the two ventricles to beat separately, instead of together. The heart's electrical system resets, and the CRT process enables the ventricles to pump in tandem again.
The leaders of the study found a disturbing situation. The study showed that only a small percentage of patients with severe heart dysfunction received the device, and those who did were disproportionately younger, white men. Researchers also found that in about 10 percent of the time, doctors who prescribed CRT did not follow published recommended clinical guidelines.

Estimations regarding CRT suggest that a third to a half of all patients hospitalized with heart failure could benefit from the device. CRT used with optimal medical treatment is likely to dramatically reduce the need for repeated hospitalization and lower the risk of untimely death.

Two years ago, the American College of Cardiology/American Heart Association strongly recommended CRT therapy for selected patients with severe heart failure, but knowledge of CRT use was little known. Investigators for the Duke study examined the records of nearly 34,000 admissions for heart failure from January 2005 to September 2007 in 228 hospitals enrolled in the American College of Cardiology/American Heart Association's "Get with the Guidelines" program, a project designed to improve the quality of heart failure care nationwide.

The researchers, tracking patients who were hospitalized with CRT in place, and those who had it when they were discharged, found that the use of the therapy varied significantly, with some hospitals not using it at all. Other hospitals showed up to 23 percent of potentially eligible patients were receiving the treatment.

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