Heart failure patients with cardiac implantable devices in an ultra-peripheral region: a real-world descriptive registry

Background

Providing specialised heart failure (HF) and device-based care in ultra-peripheral island regions is challenging due to geographic isolation and limited access to in-person follow-ups. Real-world data describing the clinical profile, arrhythmic burden and device therapies in such settings are scarce.

Objectives

To describe patient characteristics, arrhythmia burden, device therapies, healthcare utilisation and outcomes in a real-world cohort of HF patients with cardiac implantable electronic devices (CIEDs) in an ultra-peripheral region.

Methods

A retrospective observational registry was conducted, including consecutive HF patients implanted with CIEDs in an ultra-peripheral Atlantic archipelago. Demographic characteristics, device type, arrhythmias, device-based therapies, rehospitalisation for HF, follow-up duration and mortality were analysed.

Results

The cohort comprised 236 HF patients, predominantly male (75.0%), with a mean age of 66.9 ± 12.0 years. Device distribution included transvenous implantable cardioverter-defibrillators in 49.2%, cardiac resynchronisation therapy defibrillators in 36.4%, cardiac resynchronisation therapy pacemakers in 9.3% and subcutaneous defibrillators in 5.1%. Ischaemic cardiomyopathy was present in 42.4% of patients, and 55.9% were monitored remotely. Atrial fibrillation was documented in 35.6% of patients. Ventricular arrhythmias were common, with non-sustained ventricular tachycardia occurring in 30.9% of patients, ventricular fibrillation in 10.6%, and at least one episode of ventricular tachycardia or fibrillation in 8.1%. Anti-tachycardia pacing was delivered to 6.4% of patients, while appropriate shock therapy occurred in 9.7%. No inappropriate shocks were recorded.

During follow-up (median=46 months; IQR 19.8–80.3), 29.9% of patients were rehospitalised for HF at least once. All-cause mortality was 11.9%, with cardiovascular mortality accounting for 7.2%.

Conclusions

In this real-world cohort from an ultra-peripheral island region, HF patients with CIEDs exhibited a substantial burden of atrial and ventricular arrhythmias, which were frequently managed with device-based therapies and a low incidence of shocks.