■指导器械治疗(GDDT)可改善符合资格的心力衰竭(HF)患者射血分数降低(HFrEF)的预后。在2012年ACCF/AHA/HRS重点更新心脏节律异常基于设备的治疗后,HFrEF中设备治疗的利用率尚未得到很好的研究。
■使用汇总的电子健康记录(EHR)数据表征2012年至2019年新指示的HFrEF患者中GDT的使用。
■用于植入式心律转复除颤器/心脏再同步治疗除颤器(ICD/CRT-D)适应症的可计算表型算法,来自EHR中检测到的心力衰竭诊断(GLIDE-HF)适应症,程序,措施,处方,以及来自去识别的Optum®EHR数据的自然语言处理的提供商注释的输出。患者被诊断为HF,扩张型心肌病,或先前的梗塞,如果他们在2012年至2019年接受ICD或心脏除颤器再同步治疗(CRT-D)的新1类或2a类适应症前HFrEF记录>1年,则将其纳入研究.
■记录显示137,476名HFrEF患者新接受ICD或CRT-D。在36,358例(41.0%)CRT-D患者中的14,892例和101,118例(14.7%)ICD患者中的14,904例使用了GDT。虽然GDDT的使用率很低,95.7%接受了超声心动图检查,92.1%接受了β受体阻滞剂或血管紧张素转换酶/血管紧张素受体阻滞剂药物的处方。
■在这个现代的HF患者队列中,大部分符合条件的患者没有接受ICD或CRT-Ds,同时经常接受其他指定的心血管干预和治疗。
UNASSIGNED: Guideline-directed device therapies (GDDT) improve outcomes for eligible patients with heart failure (HF) with reduced ejection fraction (HFrEF). Utilization rates of device therapies in HFrEF after the 2012 ACCF/AHA/HRS Focused Update for Device-based Therapies of Cardiac Rhythm Abnormalities have not been well studied.
UNASSIGNED: Characterize the use of GDDT in newly indicated HFrEF patients from 2012 to 2019 using aggregated electronic health record (EHR) data.
UNASSIGNED: Computable phenotyping algorithms for implantable cardioverter defibrillator/cardiac resynchronization therapy-defibrillator (ICD/CRT-D) indications from the
GuideLine Indications Detected in EHR for Heart Failure program (GLIDE-HF) used diagnoses, procedures, measures, prescriptions, and the output of natural language processed provider notes from de-identified Optum® EHR data. Patients had a diagnosis of HF, dilated cardiomyopathy, or prior infarct, and were included if they had HFrEF with >1 year of records prior to a new Class 1 or Class 2a indication for an ICD or cardiac resynchronization therapy with defibrillator (CRT-D) from 2012 to 2019.
UNASSIGNED: Records showed 137,476 HFrEF patients were newly indicated for an ICD or CRT-D. GDDT was used in 14,892 of 36,358 (41.0%) CRT-D indicated patients and in 14,904 of 101,118 (14.7%) ICD-indicated patients. While GDDT use was low, 95.7% had echocardiography and 92.1% had prescriptions for beta-blockers or angiotensin-converting enzyme/angiotensin-receptor blockers medications.
UNASSIGNED: In this modern cohort of HF patients, a large proportion of eligible patients did not receive ICDs or CRT-Ds, while frequently receiving other indicated cardiovascular interventions and treatments.