Barriers to cardiac device access in heart failure patients: a multicenter study in Mexico

Marco A. Alcocer-Gamba, General Management, Centro de Estudios Clínicos de Querétaro S.C., Santiago de Qro., Mexico
Carlos A. Narváez, Cardiology Department, Hospital General ISSSTE Tacuba, Mexico City, Mexico
Alejandro Ricalde-Alcocer, General Management, Centro de Imagen y Tecnología en Intervención Vascular, Mexico City, Mexico
Moises Levinstein-Jacinto, Private Practice, Centro Médico ABC Santa Fe, Mexico City, Mexico
Carlos A. Guízar, Heart Failure Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
Alfonso Pérez-Martínez, Private Practice, Helimedica, Naucalpan de Juárez, Edomex, Mexico
Ricardo García-González, Private Practice, Instituto Cardiovascular de Mínima Invasión, Zapopan, Jal., Mexico
Judith Riesgo, Clinical Research and Medical Sciences in Latin America, Medtronic Mexico, Mexico City, Mexico
Federico Levy, Clinical Research and Medical Sciences in Latin America, Medtronic Mexico, Mexico City, Mexico
Svetlana V. Doubova, Epidemiological Research and Health Services Unit, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
Ricardo Pérez-Cuevas, Epidemiological Research and Health Services Unit, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
Claudio Muratore, Clinical Research and Medical Sciences in Latin America, Medtronic Mexico, Mexico City, Mexico

Objective: To describe the sociodemographic and clinical characteristics of patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF), assess adherence to 2017 ACC/AHA/HRS guidelines, and identify access barriers to cardiac implantable electronic devices (CIEDs). Methods: This multicenter observational cohort study was conducted from January 2020 to May 2022 and involved adults 18+ with HF and LVEF ≤ 45% across seven hospitals. It collected data on sociodemographic, clinical, pharmacological, and CIED characteristics. The analysis was conducted using descriptive statistics. Results: The study included 253 HF patients, 72% men, with an average age of 64. Main comorbidities were hypertension (62.8%), diabetes (44.3%), and overweight/obesity (60%). Most received beta-blockers (83.8%), angiotensin II receptor blockers (63.6%), and angiotensin receptor-neprilysin inhibitors (51.8%). Of 162 patients with LVEF ≤ 35%, 18.5% had CIEDs. Over 12 months, 75 patients (76.3%) were eligible for CIEDs and 2 (2.1%) for upgrades. Only four (5.3%) were implanted according to guidelines. The main reasons for not implanting CIEDs were care process issues. Many were on waiting lists (29.3%) or in evaluation (26.7%). In addition, 13% faced financial hardship or transportation costs. Conclusion: In Mexico, the use of CIEDs is low among HF patients with LVEF ≤ 35% due to poor adherence to guidelines and access barriers.

Keywords: Heart failure. Reduced ejection fraction. Cardiac implantable electronic device. ACC/AHA clinical guideline. Mexico.