Device Therapy In Heart Failure Population In New Zealand

Abstract

Heart failure (HF) is a major burden in developed and developing countries. It is known that HF patients are at risk of sudden cardiac death (SCD). The research presented within this thesis aims to add to the current knowledge in understanding the use of implantable cardioverterdefibrillators (ICDs) and cardiac resynchronisation therapy (CRT) in HF patients in New Zealand and to improve the awareness of these evidence-based device-therapy in the contemporary management of HF patients. Chapter 1 comprises a literature overview on providing background on SCD in HF patients and the role of ICDs in preventing SCD in HF management. Chapter 2 contains a literature review on CRT use in the management of selected HF patients. Chapter 3 describes a study that examines the use of cardiac resynchronisation therapypacemaker (CRT-P) versus cardiac resynchronisation therapy-defibrillator (CRT-D) in patients with impaired left ventricular ejection fraction (LVEF). Chapter 4 describes a study that evaluates the role of a simple risk score to identify HF patients who should have CRT-D versus those who should be treated with a CRT-P even when fulfilling ICD implantation criteria. Chapter 5 reports two observational studies describing the trends and utilisations as well as the outcomes of HF patients with ICD/CRT-D and CRT-P in the Northern Region of New Zealand. A third study reported the gender differences in the use of these devices in New Zealand. An overview of quality of life (QoL) of HF patients has been presented in Chapter 6 followed by a study that describe the burden of hospitalisations, using the novel concept of "Days alive and out of hospital" (DAOH) in HF patients implanted with CRT devices in the Northern Region of New Zealand. The final study in Chapter 6 describes the outcomes of HF patients with primary prevention ICD/CRT-D who underwent unit generator replacement due to battery depletion. Chapter 7 summarises the results of the studies and discusses the wider context and clinical relevance of the findings, as well as making some future research recommendations.