The Impact of Heart Failure

Heart failure (HF) is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen. It creates many personal challenges for patients, including decreased quality of life, restricted daily activities, and increased anxiety.

White icon depicting a person in a hospital bed


new HF cases are diagnosed annually in the United States — 26 million new cases worldwide.1

White icon of an H to represent a hospital

Common Cause

of hospitalizations due to cardiovascular disease in patients over 65.5

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mortality at 5 years.6

Improve Patient Survival and Quality of Life*

Although guideline-directed medication therapy (GDMT) can help to reduce mortality, often medication alone is not enough.For HF patients with electrical dyssynchrony, cardiac resynchronization therapy (CRT) — in addition to GDMT — is the only therapy clinically proven to help7:

  • Improve quality of life8,9
  • Slow HF disease progression10
  • Decrease mortality11-15
  • Reduce HF hospitalizations11-16

*Although many individuals benefit from the use of this treatment, results may vary. Risks associated with these implantable device systems include, but are not limited to, infection at the surgical site and/or sensitivity to the device material, failure to deliver therapy when it is needed, or receiving extra therapy when it is not needed.

Why CRT for Heart Failure

Few therapies in all of medicine have the breadth and depth of supporting clinical data as CRT.

Presented by
Michael Gold M.D., Ph.D., FHRS
Medtronic Global Grand Rounds
December 2018

New Data: Redefining CRT Response

In a new analysis of results from the REVERSE trial,17 mild HF patients who received CRT were classified as improved, stabilized, or worsened based upon:

  • Clinical composite score (CCS)
  • Change in left ventricular end systolic volume index (LVESVi)

Apart from rare, isolated situations, heart failure is incurable ... a slowing of a progressive disease is a positive outcome.18

Graphic showing the majority of CRT patients have better than normal progression of HF disease in the REVERSE trial

When CRT is used in patients who meet guideline-recommended indications, there is no proven patient population that experiences a negative response to CRT.18

Patients who stabilize with CRT have a much better prognosis than previously appreciated — suggesting that the current classification of “non-responder” is not appropriate.17

Clinical Trials

Major CRT clinical trials continue to show benefits for patients with electrical dyssynchrony.7-16 Clinical trials also highlight current underutilization and show the benefit of defibrillator therapy.19,20

CRT and ICD Evidence

Chart showing ICD and CRT studies done between 2011 and 2021.

Results are from different studies and are shown for illustrative purposes only. Study sizes, designs, and populations vary.

Companion11 CRT-D All-cause Mortality

Graph showing a 36% relative reduction in all-cause mortality shown in the Companion trial

n = 903, 12 months mean follow-up
(p = 0.003)

A total of 61% of patients in the pharmacologic therapy group had a moderate or severe adverse event from any cause, as compared with 66% of patients in the pacemaker group (P = 0.15) and 69% of patients in the pacemaker-defibrillator group (P = 0.03).


Impact on Hospital Economics

Heart Failure is a Growing Burden for Healthcare Systems

  • > 8 million U.S. patients projected to have HF by 203023
  • 34% of total Medicare spend attributable to HF patients24
  • > 2 per year average HF hospitalizations per Medicare patient25
  • ~$15,000 average healthcare system cost of a HF hospitalization‡25

Heart failure admissions are costly, and on average, Medicare reimbursement does not cover the hospital costs. This poses distinct challenges for healthcare providers and device patients.

Includes facility, professional, pharmacy, and patient responsibility for HF primary diagnosis.

Average Facility Margin Loss per Medical Management Hospitalization 

$1,110 to $1,540 — range of average facility margin loss per medical management HF hospitalization26

Graph showing a range of $1,110 and $1,540 facility margin loss per medical management heart failure hospitalization

Annual HF Hospitalization Rate§

Compared to medication alone, CRT-D is estimated to decrease annual HF hospitalization by 30%3
Graph showing that CRT-D is estimated to decrease annual heart failure hospitalization by 30% compared to medication alone

§Annual HF hospitalization rate estimates the average number of heart failure-related hospitalizations a patient in this cohort may have over a year. That is, in the example above, an optimal pharmacological therapy patient experiences 0.6 heart failure hospitalizations on average per year.

Increase Access to Therapy

CRT-D therapy is underutilized overall, and even more so with women and patients in underserved communities.4,21,22 By understanding our biases, together we can reverse these trends and give all patients access to lifesaving therapy.

Why Might CRT Therapy be Underutilized?

Reasons for CRT underutilization in the general population and underserved communities.

Presented by
Marc Silver, M.D.
Medtronic Global Grand Rounds 
February 2015

Female Patients are Undertreated4

Underutilization is especially pronounced in female patients.4 Studies have demonstrated a lack of female representation in clinical trials, key differences in clinical profiles, and biases in both physicians and patients.27-30

Male-focused Studies

Current guidelines are based on trials where ~80% of the patients were men.27

Profile Differences

Women with HF may have a different clinical profile and not get a left ventricular assessment.28

Device Counseling

Rates of device counseling, which can influence acceptance, are lower in women.29

Differing Symptoms

Differences in how symptoms are communicated can affect course of treatment.30

Patients with New ICD/CRT-D Indication, 2012–20164

Graph showing that 12.7% of indicated women received an ICD or CRT-D versus the 16.7% of indicated men from 2012 to 2016

Furthermore, women are shown to be different at baseline and have repeatedly shown superior outcomes from CRT than men.27

AdaptResponse Baseline31 
Differences in Women and Men

The proportion of women enrolled in the AdaptResponse trial (43%) exceeds the proportion of women in other landmark CRT studies31 and approaches the proportion of women with HFrEF in the real world. This will allow unprecedented insights into the presentation, progression, and treatment of women with HF.

Illustration showing factors that were considered in the AdaptResponse trial with men versus women

Know Who Can Benefit 

Who Can Benefit from CRT Therapy?

Understanding the indications and guidelines for qualifying patients for CRT.

Presented by
Jack Rickard, M.D.
Medtronic Global Grand Rounds
December 2018

Patients|| Who May Benefit from Co-management with an EP32

Indications of HF patients who may benefit from CRT:

  • Low LVEF
  • Wide QRS
  • Frequent RV pacing
Chart showing three indications heart failure patients may have who could benefit from an electrophysiology consult

||Patients on stable, optimal heart failure medical therapy, if indicated.

These considerations are provided for general educational purposes only and should not be the exclusive source for this type of information. At all times, it is the professional responsibility of the practitioner to exercise independent clinical judgment in a particular situation. See the device instructions for use for detailed information regarding the procedural instructions, indications, contraindications, warnings, precautions, and potential complications/adverse events:

Class I Guidelines — CRT-D


Guideline Class and LOE



NYHA Class



HF Etiology

Ischemic, nonischemic

Left Ventricular Ejection Fraction (LVEF)

≤ 35%

≤ 35%

QRS Duration and Morphology

QRS ≥ 150 ms, LBBB

RV Pacing

Not specified

Guideline-directed Medical Therapy (GDMT)


Additional Resources

Educate Your Patients 

Download conversation tools to explain the benefits of CRT-D and ICD therapies.

Therapy Awareness Programs 

We’ll work with your clinic or medical center to provide presentations, data, and resources to support your staff’s understanding of lifesaving device therapies.

Educational Resources On Medtronic Academy

Courses to increase your understanding of CRT-D therapy.

Visit Medtronic Academy
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Our CRT-D Systems

Our full line of
CRTs and LV leads.

See Devices
Attain Stability Quad LV lead on a light blue background

Our CRT-D Features

Unique features to
tailor therapy for your
patient’s needs.

Explore Features
MyCareLink Heart Mobile app home screen on a smartphone on a blue background

Managing Your Patients

Tools to keep you and your
patients connected.

Monitoring Options



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