Successful treatment of heart failure with devices requires collaboration

Karl Swedberg, John Cleland, Martin R. Cowie, Markku Nieminen, Silvia G. Priori, Luigi Tavazzi, Dirk J. van Veldhuisen, Luis Alonso-Pulpon, John Camm, Kenneth Dickstein, Helmut Drexler, Gerasimos Filippatos, Cecilia Linde, José Lopez-Sendon, Massimo Santini, Faiez Zannad

Research output: Contribution to journalArticlepeer-review


Implanted biventricular pacemakers (cardiac resynchronisation therapy, CRT) with or without implantable cardioverter defibrillators (ICD) improve survival and morbidity in some patients with chronic heart failure (CHF) who are optimally treated with pharmacologic agents according to current guidelines. Correspondingly, ICDs improve survival. However, there is only limited evidence for device treatment in certain patient subgroups, such as the impact of ICD on outcomes in patients with reduced ejection fraction in New York Heart Association (NYHA) Class I or IV heart failure. Similarly, limited evidence exists for CRT in patients with only modest QRS prolongation or only modestly reduced ejection fraction. Despite evidence for a beneficial effect of device therapy in CHF, only a minority of eligible patients are currently offered these options. Multiple reasons contribute to the underuse of these potentially life-saving therapies. A lack of adherence to guidelines by health care professionals is an important barrier. Clearly, efforts should be made to improve the standard of care and to familiarise all physicians involved in managing CHF patients with the indications and potential efficacy of these devices. Increased collaboration between structured heart failure care and pacemaker clinics as well as between electrophysiologists, heart failure clinicians, and primary care physicians is required. Such team collaborations should lead to improved care with reduced mortality and morbidity and increased cost effectiveness. Treatment strategy should be based on a structured approach tailored to local practice and national priorities.

Original languageEnglish
Pages (from-to)1229-1235
Number of pages7
JournalEuropean Journal of Heart Failure
Issue number12
Publication statusPublished - Dec 2008


  • Cardiac resynchronisation therapy
  • Chronic heart failure
  • Defibrillator
  • Device
  • Guidelines
  • Treatment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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