Optimized Implementation of cardiac resynchronization therapy: a call for action for referral and optimization of care

Wilfried Mullens, Angelo Auricchio, Pieter Martens, Klaus Witte, Martin R Cowie, Victoria Delgado, Kenneth Dickstein, Cecilia Linde, Kevin Vernooy, Francisco Leyva, Johann Bauersachs, Carsten W Israel, Lars Lund, Erwan Donal, Giuseppe Boriani, Tiny Jaarsma, Antonio Berruezo, Vassil Traykov, Zaheer Yousef, Zbigniew KalarusJens Cosedis Nielsen, Jan Steffel, Panos Vardas, Andrew Coats, Petar Seferovic, Thor Edvardsen, Hein Heidbuchel, Frank Ruschitzka, Christophe Leclercq

Research output: Contribution to journalArticlepeer-review


Cardiac resynchronization therapy (CRT) is one of the most effective therapies for heart failure with reduced ejection fraction and leads to improved quality of life, reductions in heart failure hospitalization rates and reduces all‐cause mortality. Nevertheless, up to two‐thirds of eligible patients are not referred for CRT. Furthermore, post implantation follow‐up is often fragmented and suboptimal, hampering the potential maximal treatment effect. This joint position statement from three ESC Associations, HFA, EHRA and EACVI focuses on optimized implementation of CRT. We offer theoretical and practical strategies to achieve more comprehensive CRT referral and post‐procedural care by focusing on four actionable domains; (I) overcoming CRT under‐utilization, (II) better understanding of pre‐implant characteristics, (III) abandoning the term ‘non‐response’ and replacing this by the concept of disease modification, and (IV) implementing a dedicated post‐implant CRT care pathway.
Original languageEnglish
Pages (from-to)2349-2369
Number of pages21
JournalEuropean Journal of Heart Failure
Issue number12
Early online date2 Nov 2020
Publication statusPublished - Dec 2020

Bibliographical note

This is the peer reviewed version of the following article: Mullens, W., Auricchio, A., Martens, P., Witte, K., Cowie, M.R., Delgado, V., Dickstein, K., Linde, C., Vernooy, K., Leyva, F., Bauersachs, J., Israel, C.W., Lund, L., Donal, E., Boriani, G., Jaarsma, T., Berruezo, A., Traykov, V., Yousef, Z., Kalarus, Z., Nielsen, J.C., Steffel, J., Vardas, P., Coats, A., Seferovic, P., Edvardsen, T., Heidbuchel, H., Ruschitzka, F. and Leclercq, C. (2020), Optimized Implementation of cardiac resynchronization therapy – a call for action for referral and optimization of care. Eur J Heart Fail. Accepted Author Manuscript., which has been published in final form at https://doi.org/10.1002/ejhf.2046.  This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.


  • Cardiology and Cardiovascular Medicine


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