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Association between...
Association between demographic, organizational, clinical, and socio-economic characteristics and underutilization of cardiac resynchronization therapy : results from the Swedish Heart Failure Registry.
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- Lund, Lars H (författare)
- Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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- Braunschweig, Frieder (författare)
- Karolinska Institutet,Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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- Benson, Lina (författare)
- Karolinska Institutet,Karolinska Institutet, Department of Clinical Science and Education, South Hospital, Stockholm, Sweden
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- Ståhlberg, Marcus (författare)
- Karolinska Institutet,Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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- Dahlström, Ulf, 1946- (författare)
- Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Linde, Cecilia (författare)
- Karolinska Institutet,Karolinska Institutet, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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(creator_code:org_t)
- 2017-02-07
- 2017
- Engelska.
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Ingår i: European Journal of Heart Failure. - : John Wiley & Sons. - 1388-9842 .- 1879-0844. ; 19:10, s. 1270-1279
- Relaterad länk:
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https://onlinelibrar...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- AIMS: Cardiac resynchronization therapy (CRT) improves outcomes in heart failure (HF) but may be underutilized. The reasons are unknown.METHODS AND RESULTS: We linked the Swedish Heart Failure Registry to national registries with ICD-10 (International Classification of Diseases-10th Revision) co-morbidity diagnoses and demographic and socio-economic data. In patients with EF ≤39% and NYHA II-IV, we assessed prevalence of CRT indication and CRT use. In those with CRT indication, we assessed the association between 37 potential baseline covariates and CRT non-use using multivariable generalized estimating equation (GEE) models. Of 12 807 patients (mean age 71 ± 12 years, 28% female), 841 (7%) had CRT, 3094 (24%) had an indication for but non-use of CRT, and 8872 (69%) had no indication. Important variables independently associated with CRT non-use were: HF duration <6 months [risk ratio (RR) 1.21, 95% confidence interval (CI) 1.17-1.24]; non-cardiology planned follow-up (RR 1.14, 95% CI 1.09-1.18); age >75 years (RR 1.13, 95% CI 1.09-1.18); non-cardiology care at baseline (RR 1.10, 95% CI 1.07-1.14); small-town non-university centre (RR 1.08, 95% CI 1.05-1.12); female sex (RR 1.07 95% CI 1.03-1.10) (all P < 0.05); as was absence of AF, living alone; psychiatric diagnosis; smoking; and non-use of HF drugs. Education, income, cancer, or HF characteristics were not independently associated with CRT non-use.CONCLUSION: In this population-wide HF registry, CRT was underutilized. Non-use was associated mostly with demographic and organizational, but not clinical or socio-economic factors. This calls for programmes to raise awareness of CRT indications and improve access and referrals to cardiology specialists.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- Cardiac resynchronization therapy
- Epidemiology
- Guidelines
- Heart failure
- Implementation
- Utilization
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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