Global and Temporal Trends in Utilization and Outcomes of Implantable Cardioverter Defibrillators in Hypertrophic
Omar M Abdelfattah1, Ahmed Sayed2, Ahmed Al-Jwaid3
1Hypertrophic Cardiomyopathy Center, Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (O.M.A., D.A.J., A.N.).
Insights
Implantable cardioverter defibrillator (ICD) use for hypertrophic cardiomyopathy increased significantly from 1990 to 2021. While sudden cardiac death rates declined, geographic disparities in ICD access persist, necessitating improved specialized care.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Hypertrophic cardiomyopathy is now a treatable condition.
- Limited data exist on global trends in implantable cardioverter defibrillator (ICD) use for hypertrophic cardiomyopathy.
- Understanding ICD utilization impact on mortality and morbidity is crucial.
Purpose of the Study:
- To analyze global trends in ICD utilization for hypertrophic cardiomyopathy.
- To assess the impact of ICDs on sudden cardiac death, appropriate/inappropriate shocks, and complications.
- To identify geographic variations in ICD implantation rates.
Main Methods:
- Systematic search of electronic databases up to March 2024 for studies on ICD use in hypertrophic cardiomyopathy.
- Meta-analysis using a random effects model to pool data across time, geography, and age.
- Primary outcome: global ICD utilization trends. Secondary outcomes: sudden cardiac death, shock, and complication rates.
Main Results:
- ICD implantation rates increased from 1.09% in 1990 to 4.01% in 2021.
- Appropriate ICD discharge rate was 3.44%/year; inappropriate discharge rate was 3.58%/year (declining over time).
- Sudden cardiac death rates significantly decreased from 0.84%/year in 1990 to 0.31%/year in 2020.
Conclusions:
- ICD utilization in hypertrophic cardiomyopathy has dramatically increased.
- While sudden cardiac death has declined, a direct causal link with ICDs requires further data.
- Significant geographic disparities in ICD use highlight the need for equitable access to specialized care.
Background:
Over the past decades, hypertrophic cardiomyopathy has become a contemporary treatable disease. However, limited data exist on the global trends of implantable cardioverter defibrillator (ICD) utilization and its impact on mortality/morbidity burden reduction.
Methods:
Electronic databases were systematically searched up to March 2024 for studies reporting on ICD utilization rates in hypertrophic cardiomyopathy. A random effects model was used to pool study estimates across time-era, geographic region, and age group. Primary outcome was global trends in ICD utilization. Secondary outcomes included trends of sudden cardiac death, appropriate/inappropriate shocks, and ICD-related complications.
Results:
In total, 234 studies (N=92 500, 514 748 patient-years) met inclusion criteria. Mean age was 46.2 (12.4) years and 37.49% were women. A total of 12 139 patients (16.43%) received an ICD over 429 766 person-years of follow-up, with an ICD implantation rate of 2.79%/y ([95% CI, 2.35%-3.32%] I²=97.80%). Rates of ICD implantation steadily increased over time from 1990 (1.09%) to 2021 (4.01%; P=0.002), with noticeable geographic variation (P=0.008). The overall rate of appropriate ICD discharges and ICD-related complications was 3.44%/y ([95% CI, 3.08%-3.84%] I²=88.40%) and 1.98%/y ([95% CI, 1.52%-2.59%] I²=90.44%), respectively, with no significant trend over time. The overall rate of inappropriate discharges was 3.58%/y ([95% CI, 3.08%-4.16%] I2=88.03%), and declined significantly over time (P=0.044). There was a significant decline in the rates of sudden cardiac death from 1990 (0.84%/y) to 2020 (0.31%/y).
Conclusions:
Dramatic increases in ICD utilization have occurred, representing a 3.7-fold increase, with appropriate therapies occurring in 3.44%/y. In parallel a significant reduction in sudden cardiac death was observed, but there are insufficient data to demonstrate that a causative relationship exists. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy.
Registration:
URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42023407126.
