Abstract 18829: Cardiac Resynchronization Therapy Among Patients With Heart Failure With Reduced Ejection Fraction and Right Bundle Branch Block: A United States Population Based Study

BACKGROUND: Little is known about the efficacy of cardiac resynchronization therapy (CRT) in patients with heart failure with reduced ejection fraction (HFREF) and right bundle branch block (RBBB). The objective of this study was to assess utilization of CRT in the United States, selected inpatient outcomes, and associated patient and hospital characteristics. METHODS: We screened hospital discharges from the 2002-2010 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. ICD-9-CM diagnosis codes 428.20-428.23 were used to identify primary HFREF and ICD-9-CM code 426.4 was used to identify any RBBB. Patients who underwent CRT were identified using ICD-9-CM procedure codes. Discharge weights were used to measure national estimates. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed. RESULTS: Of 13,590 HFREF patients with RBBB, only 1368 (10%) underwent CRT during 2002-2010 in the United States. No CRT was done in 2002. Utilization of CRT among HFREF with RBBB patients increased from 0.4% in 2003 to 20% in 2010 (50 times increase, P for Trend <0.001). Predictors of CRT utilization were younger age, male gender, white race, elective admission, urban-teaching hospital, private insurance status and <2 comorbidities. Compared to patients who did not receive CRT, those with CRT had significant shorter length of stay (4.7 vs. 5.1 days, P<0.001), but higher in-hospital charges (135,099 vs 33,400 USD, P<0.001). Overall, in-hospital mortality rate was 2.5% (335/13,590); however, not a single in-hospital death occurred among those who received CRT. CONCLUSIONS: The numbers (and proportions) of CRT among HFREF with RBBB patients in the United States increased steadily increased from 2002 to 2010. CRT recipients had a significant reductions in hospital length of stay and increases in hospital charges. Further studies are needed to estimate the association of CRT and long-term outcomes.