PURPOSE: Chronic heart failure (CHF) is a major public health challenge. Recent trials show a mortality benefit from ICDs in patients (pts) with low EF and show both a mortality and symptom benefit from CRT-ICD for advanced symptoms and widened QRS. However, the specific need is unknown for a primary rural population with previously low device penetrance. The Chabert Heart Failure Program in Louisiana delivers care through a unique health care system focused on the indigent rural population. This study evaluates the potential for expanding ICD and CRT therapy into this population.
METHODS: Data from 451 CHF pts were entered at the time of CHF program enrollment 2002-4. Proposed criteria used for CRT were: LVEF < 35%, NYHA III-IV, and QRS > 120 msec modified to > 150. For ICD, EF < 30 % for all etiologies was applied and then re-applied with LVEF < 35%.
RESULTS: Mean age was 57 years, 65% male, 37% black, mean LVEF 33%, 68%NYHA II & III, median income $11,800, payer status: 70% free care, 23% Medicaid, 7% Medicare. At enrollment, only 30 pts had ICD, 5 more had CRT (7.8% total). Using EF < 30% for primary ICD identified 185 (41%) pts, increasing to 266 (59%) for EF < 35%. For CRT, 39 (8.6%) pts were eligible with QRS > 120 msec. QRS > 150 identified only 19 (4%) pts. Expected enrollment rates with these data predict an additional 82 new pts/yr for ICD (95% CI, 63 to 101) and 13 for CRT-ICD (95% CI, 5 to 21) from this site.
CONCLUSION: Where current device penetration is currently only 7.8%, approximately half of patients in an indigent rural population would be eligible by expanded criteria for devices, mostly ICD.
CLINICAL IMPLICATIONS: It is not known how these criteria would affect insured urban populations, nor how the benefits in trial populations would translate to the indigent setting. Health policy regarding allocation of such resources into indigent CHF populations is needed.
DISCLOSURE: Lee Arcement, None.