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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

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Performance of 2014 NICE defibrillator implantation guidelines in heart failure risk stratification

Richard M Cubbon1, Klaus K Witte1, Lorraine C Kearney1

  • 1Leeds Institute of Cardiovascular and Metabolic Medicine, The University of Leeds, Leeds, UK.

Heart (British Cardiac Society)
|February 10, 2016
PubMed

Insights

The updated National Institute for Health and Care Excellence (NICE) guidelines (TA314) identify patients at higher risk for sudden cardiac death (SCD) and appropriate implantable cardioverter-defibrillator (ICD) shock. However, clinical context and absolute risk are crucial for treatment decisions.

Area of Science:

  • Cardiology
  • Medical Devices
  • Public Health Policy

Background:

  • The National Institute for Health and Care Excellence (NICE) Technology Appraisal 314 (TA314) provides updated guidance on implantable cardioverter-defibrillator (ICD) use in chronic heart failure.
  • Assessing the real-world performance of these guidelines is crucial for optimizing patient selection and resource allocation.

Purpose of the Study:

  • To evaluate the effectiveness of TA314 in identifying patients with chronic heart failure and reduced left ventricular ejection fraction (LVEF) at increased risk of sudden cardiac death (SCD) or appropriate ICD shock.
  • To compare the risk profiles of patients meeting and not meeting TA314 criteria, considering comorbidities like diabetes and cardiomyopathy type.

Main Methods:

  • A multicentre prospective cohort study involving 1026 patients with stable chronic heart failure (LVEF ≤45%) recruited from UK cardiology outpatient departments.
  • Analysis focused on the capacity of TA314 criteria to predict SCD, appropriate ICD shock, and mortality from cardiovascular and non-cardiovascular causes.

Main Results:

  • The overall incidence of SCD or appropriate ICD shock was 2.1 events per 100 patient-years.
  • Patients meeting TA314 criteria had a 2.5-fold increased relative risk of SCD or appropriate ICD shock.
  • Patients with diabetes or ischaemic cardiomyopathy not meeting TA314 criteria showed risks comparable to those meeting criteria but without these specific conditions.

Conclusions:

  • TA314 effectively identifies patients with reduced LVEF at increased relative risk for SCD.
  • Clinicians must integrate the absolute risk of SCD and individual patient context into discussions regarding ICD therapy benefits and risks.
Abstract

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