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ICD Implantation Rates in Cardiac Arrest Survivors in Canada
Farzad Darabi1,2, Nigel S Tan1,2, Katherine S Allan1,2
1Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
Insights
Implantable cardioverter defibrillator (ICD) use in out-of-hospital cardiac arrest (OHCA) survivors potentially eligible for secondary prevention is increasing but remains underutilized. This trend highlights persistent gaps in guideline-concordant care for OHCA patients.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Out-of-hospital cardiac arrest (OHCA) survivors face a high risk of recurrent events.
- Implantable cardioverter defibrillators (ICDs) are recommended for secondary prevention in eligible OHCA patients.
- Current data on guideline-concordant ICD use in OHCA survivors is limited.
Purpose of the Study:
- To determine the rate of ICD implantation among OHCA survivors potentially eligible for secondary prevention.
- To analyze trends and disparities in ICD implantation over time and by healthcare setting.
Main Methods:
- Retrospective analysis of the Canadian Institute for Health Information Discharge Abstract Database (2013-2017).
- Inclusion of OHCA patients surviving to discharge, excluding those with ischemic or bradycardia etiology.
- Estimation of ICD implantation rates in potentially eligible patients.
Main Results:
- Of 4,486 OHCA survivors, 2,580 (57.5%) were potentially eligible for an ICD.
- Only 757 (29.3%) of eligible patients received an ICD.
- ICD implantation rates increased from 13.8% (2013) to 19.6% (2017), with higher rates in urban and teaching hospitals.
Conclusions:
- Despite an increasing trend, ICD utilization remains significantly underused in eligible OHCA survivors.
- Disparities in ICD implantation exist based on geographic location and hospital type.
- Further efforts are needed to ensure guideline-concordant care for OHCA patients.
Background:
Patients resuscitated from out-of-hospital cardiac arrest (OHCA) are at high risk of recurrence, posing a substantial burden on healthcare systems. Despite the established benefit of implantable cardioverter defibrillator (ICD) therapy in many such patients, and recommendations by guidelines, few studies have described the proportion of OHCA patients who receive guideline-concordant care.
Methods:
The Canadian Institute for Health Information Discharge Abstract Database dataset was used to identify OHCA patients admitted to hospitals across Canada, excluding Quebec. We analyzed all patients without a probable ischemic or bradycardia etiology of cardiac arrest, who survived to discharge, to estimate the ICD implantation rates in patients who were potentially eligible to have an ICD.
Results:
Between 2013 and 2017, a total of 10,435 OHCA patients who were admitted to the hospital were captured in the database; 4486 (43%) survived to hospital discharge, and 2580 survivors (57.5%) were potentially eligible to receive an ICD. Among these potentially eligible patients, 757 (29.3%) received an ICD during their index admission or within 30 days after discharge from the hospital. The ICD implantation rate during index admission increased from 13.8% in 2013 to 19.6% in 2017 (P-value for time trend < 0.05). The rate of ICD implantations in potentially eligible patients was higher in urban than in rural settings (19.5% vs 11.1%) and in teaching vs community hospitals (34.7% vs 9.8%).
Conclusions:
Although ICD implantation rates show an increasing trend among patients with OHCA who are likely eligible for secondary prevention, significant underutilization of ICDs persists in these patients.
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