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Consideration for primary prevention implantable cardioverter defibrillators differ between specialities

Amar Mistry1,2, Zakariyya Vali3,2, Abu Taher2

  • 1Department of Cardiovascular Science, University of Leicester, Leicester, UK amarmistry@nhs.net.

Postgraduate Medical Journal
|May 18, 2019
PubMed

Insights

Patients managed by cardiologists are more likely to be considered for an implantable cardioverter defibrillator (ICD) for primary prevention. This highlights variations in ICD consideration, impacting patient outcomes and survival rates.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Preventive Medicine

Background:

  • Implantable cardioverter defibrillator (ICD) implantation rates for primary prevention of sudden cardiac death are variable.
  • Guideline recommendations for ICDs exist but are not uniformly applied.

Purpose of the Study:

  • To assess if management by a cardiologist influences consideration for ICD implantation in patients with severe left ventricular systolic dysfunction (LVSD).
  • To evaluate the impact of physician specialty on ICD consideration and patient outcomes.

Main Methods:

  • Retrospective, observational study of 129 patients with severe LVSD identified via echocardiography.
  • Patients were categorized into three management groups: electrophysiologist/heart failure specialist, other cardiologists, and non-cardiologists.
  • ICD consideration and 1-year survival were assessed cross-sectionally.

Main Results:

  • 47.3% of patients with severe LVSD were not considered for an ICD.
  • Patients managed by cardiologists were significantly more likely to be considered for an ICD compared to non-cardiologists (63.9% vs. 30.0%).
  • Management by an electrophysiologist/heart failure specialist further increased the likelihood of ICD consideration compared to other cardiologists.

Conclusions:

  • Physician specialty significantly impacts the consideration of ICD therapy for primary prevention.
  • Variations exist among cardiologists and between cardiologists and non-cardiologists in recommending ICDs.
  • Optimizing physician awareness and adherence to guidelines may improve ICD utilization for eligible patients.
Abstract

Keywords:
implantable cardioverter-defibrillatorleft ventricular systolic impairmentsudden cardiac death prevention

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