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Effectiveness of wearable defibrillators: systematic review and quality of evidence
Jennifer Uyei1, R Scott Braithwaite1
1Division of Comparative Effectiveness and Decision Sciences,Department of Population Health,New York University School of Medicine.
Insights
Wearable defibrillators may reduce deaths from ventricular tachycardia and fibrillation (VT/VF). However, current evidence quality is low, necessitating further research to confirm these findings.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Evidence
Background:
- Sudden cardiac death remains a significant concern, particularly in patients with compromised heart function.
- Wearable cardioverter-defibrillators (WCDs) offer a non-invasive option for managing arrhythmia risk.
- Assessing the real-world efficacy and effectiveness of WCDs is crucial for clinical practice.
Purpose of the Study:
- To systematically review literature on wearable defibrillators.
- To evaluate WCD efficacy and effectiveness in diverse patient populations.
- To assess the quality of evidence supporting WCD use.
Main Methods:
- Systematic literature review adhering to PRISMA guidelines.
- Quality of evidence assessed using GRADE and Newcastle Ottawa Scale.
- Inclusion of 33 studies comprising 36 articles and abstracts.
Main Results:
- Wearable defibrillator use showed a potential reduction in VT/VF associated deaths.
- An approximate 1% absolute risk reduction in mortality was observed.
- The overall quality of evidence was rated as low to very low.
Conclusions:
- Current evidence suggests a potential benefit of wearable defibrillators.
- The low quality of evidence necessitates caution in interpretation.
- Further high-quality, independent research is required to validate findings.
Objectives:
The objectives of this systematic literature review were to identify all published literature on wearable defibrillators, assess the wearable defibrillator's efficacy and effectiveness in general and among specific patient groups, including post-myocardial infarction, post coronary artery bypass grafting or percutaneous coronary intervention, non-ischemic cardiomyopathy, and ischemic cardiomyopathy, and to evaluate the quality of evidence.
Methods:
The search and synthesis was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation and the Newcastle Ottawa Scale.
Results:
A total of thirty-six articles and conference abstracts from thirty-three studies were included in the review. It appears that wearable defibrillator use compared with no defibrillator use reduces the chance of ventricular tachycardia and ventricular fibrillation (VT/VF) associated deaths by an absolute risk reduction of approximately 1 percent, achieved by averting approximately 4/5th of all VT/VF associated deaths. The quality of evidence was low to very low quality, such that our confidence in the reported estimates is weak.
Conclusions:
To validate beneficial results, further investigation using robust study designs conducted by independent researchers is warranted.
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