Related Experiment Video
Updated: Jun 18, 2025
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Compliance with Guideline-Directed Medical Therapy and Early Implantable Cardioverter-Defibrillator Activation in
Ivan Prepolec1, Vedran Pašara1, Andrija Nekić2
1Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
Insights
Optimal medical therapy (OMT) compliance was low in heart failure with reduced ejection fraction (HFrEF) patients before implantable cardioverter-defibrillator (ICD) implantation. Early ICD activation was rare, suggesting OMT may influence device necessity.
Area of Science:
- Cardiology
- Heart Failure Management
- Medical Device Therapy
Background:
- Guideline-directed optimal medical therapy (OMT) is crucial for heart failure with reduced ejection fraction (HFrEF).
- Implantable cardioverter-defibrillators (ICDs) are used for primary prevention in HFrEF.
- Compliance with OMT before ICD implantation is not well-understood.
Purpose of the Study:
- To evaluate OMT compliance in HFrEF patients undergoing ICD implantation.
- To assess the association between OMT compliance and early ICD activation.
Main Methods:
- Retrospective analysis of 307 HFrEF patients who received ICDs for primary prevention (2011-2017).
- Assessment of OMT adherence (maximum tolerated dose, medication classes).
- Evaluation of early ICD activation rates and left ventricular ejection fraction (EF) changes.
Main Results:
- Only 23.8% received maximum OMT dose; 59.0% received all three OMT medication classes.
- No significant OMT compliance difference between ischemic cardiomyopathy (ICM) and non-ischemic dilated cardiomyopathy (DCM) patients.
- Early ICD activation was infrequent (<3%) across all groups, particularly in those without OMT.
Conclusions:
- Suboptimal OMT compliance is prevalent in HFrEF patients prior to ICD implantation.
- Early ICD activation is rare, irrespective of OMT status, suggesting potential for delayed device evaluation.
- Further research on optimal waiting periods for EF improvement and ICD eligibility is warranted.
Background:
This study was conducted to evaluate compliance with guideline-directed optimal medical therapy (OMT) and its association with early implantable cardioverter-defibrillator (ICD) activation in patients with heart failure and reduced ejection fraction (HFrEF).
Methods:
Retrospective data from 307 patients who underwent ICD implantation for primary prevention from 2011 to 2017 were collected and analyzed.
Results:
Among the study participants, only 23.8% received the maximum tolerated dose of OMT prior to ICD implantation, with 59.0% receiving all three OMT medication groups. No significant difference in OMT compliance was found between patients with ischemic cardiomyopathy (ICM) and those with non-ischemic dilated cardiomyopathy (DCM). However, DCM patients received ICDs more frequently at the time of diagnosis than ICM patients (13.8% vs. 0.7%). Early ICD activation (within 3 months) occurred in only one patient who had not received appropriate OMT, representing 0.7% of all ICM patients. Furthermore, early activation was also infrequent in patients who received OMT (2.9% of ICM patients and 2.6% of DCM patients). Echocardiography follow-up data revealed that 20.4% of ICM patients and 29.8% of DCM patients who did not receive OMT before ICD implantation showed improvement in the left ventricular ejection fraction (EF) to 35% or more.
Conclusions:
This study found suboptimal compliance with OMT prior to ICD implantation in HFrEF patients. The results showed that early ICD activation was rare in all patient groups, especially those who did not receive the prescribed 3 months of OMT. More research is needed to investigate longer waiting periods for the evaluation of potential EF improvement, and to better evaluate the eligibility of HFrEF patients for ICD. The current findings have potential implications for clinical practice and patient outcomes.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:26Heart Failure Drugs: Inotropic Agents
01:22Heart Failure Drugs: β-Blockers
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...