Strategies for reducing sudden cardiac death: application of microvolt T-wave alternans testing in clinical practice

The public health challenge of preventing sudden cardiac death (SCD) is significant. Various risk factors for SCD have been well articulated from clinical trials and the importance of reduced left ventricular ejection fraction (LVEF) has been validated. However, significant challenges persist in identifying which patients are most vulnerable to SCD, particularly in the setting of preserved left ventricular systolic function. The current article outlines strategies to capture high-risk patients. This strategy includes the implementation of noninvasive risk stratification with microvolt T-wave alternans (MTWA) as well as utilizing health information technology (HIT) to identify patients at risk. The application of HIT in a clinic setting provides electronic decision support tools to document adherence to currently published cardiovascular practice guidelines. Electronic alerts facilitate measurement of LVEF as well as ensure that patients are receiving optimal pharmacologic therapy. A process of care is outlined for patients who are discharged post myocardial infarction and post congestive heart failure hospitalization. This coupled with educational information provided to families and primary care physicians is supportive of an overall process of care focused on SCD prevention. The current article outlines the role of implementing these strategies in a community practice setting to potentially reduce the burden of SCD.