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Published on: February 28, 2012
Factors Associated With Non-Uptake of Implantable Cardioverter-Defibrillator (ICD) Among Eligible Patients at a
Emmanuel Oluoch1, Jasmit Shah1,2, Mohamed Varwani1
1Department of Internal Medicine, Aga Khan University, Nairobi, Kenya.
Insights
Implantable Cardioverter-Defibrillators (ICDs) are underused in Kenyan heart failure patients due to cost and lack of insurance. Early specialist referral is crucial for improving access to these life-saving devices for sudden cardiac death prevention.
Area of Science:
- Cardiology
- Public Health
- Medical Devices
Background:
- Implantable Cardioverter-Defibrillators (ICDs) are proven effective for preventing Sudden Cardiac Death (SCD) in at-risk populations.
- ICD implantation rates are notably low in Africa, with limited data on non-uptake factors.
Purpose of the Study:
- To identify factors associated with the low uptake of ICDs among heart failure (HF) patients with reduced ejection fraction (EF < 35%).
- To review reasons for ICD refusal among eligible patients.
Main Methods:
- A retrospective study was conducted on HF patients eligible for ICD implantation between 2018 and 2020.
- A comparative analysis was performed between ICD recipients and non-recipients to determine non-uptake determinants.
Main Results:
- Only 33.5% of eligible patients (69 out of 206) received an ICD.
- Key factors associated with non-uptake included lack of private insurance (42.3% vs 63.8%), non-cardiology physician (16.1% vs 5.8%), and non-ischemic cardiomyopathy (54.7% vs 36.4%).
- The primary reason for ICD refusal was the inability to afford the device (75%).
Conclusions:
- ICDs are significantly underutilized in Kenya among eligible HF patients with reduced EF.
- Lack of private insurance, non-ischemic cardiomyopathy, and non-specialist physician care are significant barriers to ICD adoption.
- Timely referral of HF patients to specialists is essential for optimizing medical therapy and facilitating appropriate ICD recommendations.
Background:
Efficacy of Implantable Cardioverter-Defibrillator (ICD) implantation in both primary and secondary prevention of Sudden Cardiac Death (SCD) in at-risk population is well established. ICD implantation rates remain low particularly in Africa with a paucity of data regarding factors associated with non-uptake.
Objectives:
The primary study objective was to determine the factors associated with non-uptake of ICD among heart failure (HF) patients with reduced ejection fraction (EF<35%). Reasons for ICD refusal among eligible patients were reviewed as a secondary objective.
Methods:
This was a retrospective study among HF patients eligible for ICD implantation evaluated between 2018 to 2020. Comparison between ICD recipient and non-recipient categories was made to establish determinants of non-uptake.
Results:
Of 206 eligible patients, only 69 (33.5%) had an ICD. Factors independently associated with non-uptake were lack of private insurance (42.3% vs 63.8%; p = 0.005), non-cardiology physician (16.1% vs 5.8%; p = 0.045) and non-ischemic cardiomyopathy (54.7% vs 36.4% p = 0.014). The most common (75%) reason for ICD refusal was inability to pay for the device.
Conclusion:
ICDs are underutilized among eligible HF with reduced EF patients in Kenya. The majority of patients without ICD had no private insurance, had non-ischemic cardiomyopathy and non-cardiology primary physician. Early referral of HF with reduced EF patients to HF specialists to optimize guideline-directed medical therapy and make ICD recommendation is needed.
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