The aim of this study was to document clinical practice in Tunisia regarding the use of electronic cardiac devices in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF).

This is an ancillary analysis of the prospective NATURE HF registry (National TUnisian REgistry of Heart Failure). Between October 2017 and January 2019, we prospectively registered information of patients with heart failure and they were followed for one year.

We analyzed data of patients with a diagnosis of HF, LVEF <35% and indication for cardiac resynchronization therapy (CRT) devices with or without cardioverter-defibrillator, at the beginning of the study. Patients were followed for one year according to the practice of each center.

A total of 2040 patients were included in the registry. Fifty-six of them received a CRT pacemaker (CRT-P; 40 patients) or CRT defibrillator (CRT-D; 16 patients).

Mean age was 62 years and the most frequent causes of HF were ischemic. Overall mortality at one year was 16.1%.

The hospitalization rate was 19.6%, significantly higher in patients with CRT-D than with CRT- P (12.5% vs. 37,5%, P=0.03).

The mortality rate was 16.1%, without any statistically significant difference in patients with CRT-P or CRT-D (12.5% vs. 25%, P=0.25) (Fig. 1).

The NATURE HF registry shows that the use of cardiac resynchronization therapy in HF with reduced LVEF in Tunisia is in accordance with international recommendations but with lower rates which could be explained by the low income of the population.