ICD Implantation Rates in Cardiac Arrest Survivors in Canada

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.