Misunderstood or Mistrusted? The Under-Utilization of the Wearable Cardioverter Defibrillator in Clinical Practice

Area of Science:

• Cardiology
• Medical Technology
• Public Health

Background:

• Sudden cardiac death claims over 300,000 lives annually in the U.S.
• Cardiomyopathy patients with reduced ejection fraction are at high risk.
• Implantable cardioverter defibrillators are not suitable for all high-risk patients.

Purpose of the Study:

• To identify reasons for the under-prescription of wearable cardioverter defibrillators (WCDs).
• To explore barriers hindering WCD utilization in clinical practice.
• To propose strategies for overcoming these barriers and improving WCD adoption.

Main Methods:

• Review of current literature and clinical guidelines.
• Analysis of potential barriers including guideline confusion, prescriber uncertainty, efficacy debates, cost, and patient adherence.
• Discussion of social and educational factors influencing WCD prescription.

Main Results:

• Wearable cardioverter defibrillators (WCDs) are under-prescribed despite FDA approval and Class IIa/IIb guideline recommendations.
• Key barriers include confusion regarding prescription guidelines, prescriber eligibility, and perceived device efficacy.
• Patient-related factors like cost and adherence also contribute to under-utilization.

Conclusions:

• There is a significant gap between the demonstrated efficacy of WCDs and their clinical application.
• Improved education and clearer guidelines are needed to address WCD under-prescription.
• Further research and open discourse are essential to enhance WCD use in managing sudden cardiac death risk.