Referral Patterns for Primary Prophylaxis Implantable Cardioverter Defibrillator Therapy for an Urban US Population

Area of Science:

• Cardiology
• Medical Devices
• Public Health

Background:

• Implantable cardioverter defibrillators (ICDs) are proven to enhance survival for sudden cardiac arrest prevention.
• Existing research indicates that ICD therapy is frequently underutilized among eligible individuals.
• Concerns exist regarding potential sex and racial disparities in ICD adoption.

Purpose of the Study:

• To analyze referral patterns for prophylactic ICD implantation in high-risk patients.
• To assess associations between patient demographics and ICD referral/implantation decisions.
• To identify barriers to ICD utilization in a diverse urban academic medical center.

Main Methods:

• Retrospective review of electronic hospital databases for patients meeting prophylactic ICD criteria.
• Analysis of 1,055 patients, evaluating gender, age, race, and primary language.
• Assessment of referral rates, implantation decisions, patient refusal, and co-morbidities.

Main Results:

• 63.7% of eligible patients were referred for ICD evaluation; 345 underwent implantation.
• Gender, race, and primary language did not significantly influence referral or implantation.
• Older patients were less likely to be referred and more likely to refuse ICDs; 14% of eligible patients were not considered.

Conclusions:

• Referral rates for ICD consideration at this center exceeded previous reports.
• A significant proportion (14%) of appropriate patients were not considered for prophylactic ICDs.
• Enhanced education for patients and referring physicians is crucial to improve ICD utilization.