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New ESC Guidelines on Heart Failure Device Therapy — Implementation Challenges
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Dr. Emma Richardson
Feb 17, 2026 7:37 PM
Consultant · Heart Failure & Transplant · Royal Brompton Hospital
New ESC Guidelines on Heart Failure Device Therapy — Implementation Challenges
The updated ESC guidelines have expanded indications for CRT and ICD therapy. We\'re seeing a significant increase in referrals at Royal Brompton, which is straining our capacity.
Two practical questions for the group:
1. How are your institutions handling the increased volume?
2. Are you using any risk stratification tools beyond LVEF to prioritize patients?
We\'ve started piloting an AI-based ECG analysis tool that identifies CRT super-responders with ~85% accuracy. Early results are promising but the validation cohort is still small.
Clinical discussion
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1 reply
Interesting about the AI ECG tool, Emma. We\'ve been using cardiac MRI with strain analysis as our primary tool for identifying CRT responders. The combination of mechanical dyssynchrony on CMR + electrical criteria has improved our response rates to ~75%.
Regarding volume — we\'ve created a dedicated device clinic with nurse-led triage. That alone cut our wait times by 40%.
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