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Real-World Economic Burden Among Patients With And Without Heart Failure Worsening After Cardiac Resynchronization Therapy



Although cardiac resynchronization therapy (CRT) has the potential to improve cardiac function in patients with heart failure (HF), a considerable portion of patients do not respond to therapy. This study assessed the economic burden among patients with and without HF worsening after receiving CRT in real-world practice.


In this retrospective claims-based study using Optum’s de-identified Clinformatics® Data Mart Database (January 2007–December 2018), adults who received CRT were stratified into two cohorts based on whether they showed evidence of HF worsening within 180 days post-CRT implantation. Inverse probability of treatment weighting (IPTW) was used to adjust for confounding, accounting for demographics (e.g., age, sex), the Quan–Charlson Comorbidity Index, other clinical characteristics, healthcare resource utilization (HRU), and healthcare costs during the 180 days pre-CRT (baseline period). Annualized all-cause and congestive HF-related HRU and healthcare costs from payer and patient perspectives were assessed from day 181 post-CRT (follow-up period), and compared between cohorts using incidence rate ratios (IRRs) and cost ratios (CRs).


This study included 12,753 patients (n = 4785 with HF worsening; n = 7968 without). Mean age was 72 years and roughly two-thirds were male. Baseline characteristics were balanced between cohorts post-IPTW. During follow-up, patients with HF worsening had significantly greater annual all-cause inpatient [adjusted IRR (95% confidence interval) = 1.55 (1.44, 1.66), p < 0.001], outpatient [adjusted IRR = 1.46 (1.32, 1.61), p < 0.001], and emergency department [adjusted IRR = 1.31 (1.22, 1.41), p < 0.001] visits. Mean annual total per patient payer-paid amounts were significantly higher for patients with HF worsening versus without HF worsening [adjusted CR = 1.68 (1.56, 1.80), p < 0.001]. Annual patient-paid medical costs were also higher for patients with HF worsening [adjusted CR = 1.31 (1.25, 1.38), p < 0.001]. Results were similar for congestive HF-related HRU and costs.


The incremental economic burden among patients with HF worsening following CRT is substantial. Efforts aimed at CRT optimization may help reduce this burden.

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Sponsorship for this study and the Rapid Service Fee were funded by Medtronic.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Medical Writing, Editorial, and Other Assistance

Editorial assistance in the preparation of this article was provided by Gloria DeWalt, PhD, an employee of Analysis Group, support for this assistance was funded by Medtronic.


Eugene S. Chung receives consulting honoraria from Medtronic, Abbott, EBR Systems. John Rickard has received consulting fees from Medtronic as well as speaking fees and research funding from Abbott. Xiaoxiao Lu is an employee of Medtronic. Maral DerSarkissian, Miriam L. Zichlin, Hoi Ching Cheung, Natalia Swartz, and Alexandra Greatsinger are employees of Analysis Group, which received research funding for the conduct of this study.

Prior Presentation

Preliminary findings from this study were presented at the Heart Rhythm Society 2020 virtual congress.

Compliance with Ethics Guidelines

Data in the CDM are statistically de-identified under the Expert Determination method, comply with the Health Insurance Portability and Accountability Act, and are managed according to Optum customer data use agreements [14]. The study and use of the data did not require approval or oversight from an institutional review board. The approval to access the data was granted via a licensing agreement with Optum.

Data Availability

The datasets generated and/or analyzed during the current study are not publically available due to licensing agreement with Optum Clinformatics© Data Mart Database.

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Correspondence to Maral DerSarkissian.

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Chung, E.S., Rickard, J., Lu, X. et al. Real-World Economic Burden Among Patients With And Without Heart Failure Worsening After Cardiac Resynchronization Therapy. Adv Ther 38, 441–467 (2021).

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  • Cardiac resynchronization therapy
  • Economic burden
  • Healthcare resource utilization
  • Heart failure
  • Heart failure worsening