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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Use of beta-blockers in patients with an implantable cardioverter defibrillator
Nancy M Allen LaPointe1, Judith A Stafford, Paul A Pappas
1School of Medicine, Duke University, Duke Clinical Research Institute, Durham, NC 27705, USA. allen003@mc.duke.edu
Insights
Beta-blocker use was suboptimal among patients receiving implantable cardioverter defibrillators (ICDs). This highlights a need for improved integration of evidence-based medications in clinical practice for complex cardiac patients.
Area of Science:
- Cardiology
- Clinical Practice Guidelines
- Pharmacotherapy
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for preventing sudden cardiac arrest.
- Beta-blockers are recommended for most ICD recipients, but their usage patterns are not well-documented.
- Potential lack of awareness among clinicians regarding beta-blocker recommendations for ICD patients.
Purpose of the Study:
- To investigate the utilization of beta-blockers in patients who received an implantable cardioverter defibrillator (ICD).
Main Methods:
- Retrospective analysis of 804 adult patients receiving their first ICD between 1999 and 2004.
- Assessment of beta-blocker prescription at discharge and continued use.
- Comparison of characteristics between beta-blocker users and non-users.
Main Results:
- 68% of ICD recipients received beta-blockers at discharge; usage remained stable from 1999-2004.
- Beta-blocker use was higher in secondary prevention (69%) vs. primary prevention (60%) groups.
- Users had higher rates of ischemic heart disease, heart failure, myocardial infarction, and ventricular arrhythmias.
Conclusions:
- Suboptimal beta-blocker use indicates a gap in implementing evidence-based guidelines.
- There is a need for enhanced strategies to ensure appropriate medication use in complex cardiac patients with multiple guidelines.
- Further research into effective methods for integrating guideline-recommended medications is warranted.
Background:
Implantable cardioverter defibrillators (ICDs) are indicated for both primary and secondary prevention of sudden cardiac arrest. beta-Blockers are also indicated in most patients who have an indication for an ICD; however, their use in this population is not well described. Some clinicians may be unaware of the recommendation for beta-blockers in this population.
Objective:
To explore beta-blocker use among ICD recipients.
Methods:
Adults who received their first ICD at Duke Hospital between July 1999 and July 2004 for primary or secondary prevention of sudden cardiac arrest were identified. Using hospital data, beta-blocker use was determined at time of discharge, and characteristics of users were compared with those of nonusers. Continued use of beta-blockers after ICD implant was explored in the subset of patients included in the Duke Databank for Cardiovascular Disease (DDCD).
Results:
The study cohort comprised 804 patients, 652 (81%) with ICD for secondary prevention of sudden cardiac arrest and 152 (19%) for primary prevention. The median age was 65 years and 75% of the patients were men. A total of 544 (68%) received a beta-blocker at time of ICD implant. There were no substantial changes in the proportion of patients with beta-blocker use from 1999 through 2004, overall or within the primary or secondary prevention groups. However, beta-blocker use was higher in the secondary prevention group than in the primary prevention group (69% vs 60%; p = 0.02). A higher proportion of beta-blocker users versus nonusers had ischemic heart disease (82% vs 68%; p < 0.0001), heart failure (84% vs 71%; p < 0.0001), previous myocardial infraction (51% vs 44%; p = 0.05), and ventricular arrhythmias (82% vs 76%; p = 0.04). Of the 425 patients included in the DDCD, only 241 (57%) were receiving beta-blockers at time of implant and during clinical follow-up.
Conclusions:
Lower than optimal use of beta-blockers suggests the need for new methods of including evidence-based medications in clinical practice, especially for complex patients for whom numerous clinical practice guidelines may apply.
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