41 A multi-centre analysis of the rates of guideline-directed implantable cardiac defibrillator implantation for heart failure with reduced ejection fraction: comparing centres with and without electrophysiology services. (30th September 2020)

• Record Type: Journal Article
• Authors: Keane, S; Gallen, R; Murphy, T; Carron, J; Elmadi, M; Quinn, S
• Is Part Of: Heart. Volume 106(2020)Supplement 4
• Page Start: A27
• Page End: A27
• Publication Date: 2020-09-30
• Subjects: Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2020-ICS.41
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: Implantable Cardiac Defibrillators (ICD) are a potentially lifesaving therapy inserted for multiple indications. The indications for insertion of ICDs are stated in the European Society of Cardiology guidelines, and American Heart Association guidelines. One of the most common indications is for implantation in heart failure with reduced ejection fraction (HFrEF). These include patients with New York Heart Association (NYHA) Class I-III in patients with ischaemic cardiomyopathy (ICM) and NYHA Class II-III in patients with non-ischaemic cardiomyopathy (NICM). Purpose: While ICDs are not exclusively implanted by electrophysiologists in the country of study, we hypothesised that a hospital having a dedicated electrophysiology service would lead to greater compliance with current guidelines. Methods: We compared two major tertiary referral centres, one of which has the largest Electrophysiology (EP) service in the country, with the other currently having no EP physician. We obtained a list of all patients who attended the respective Heart Failure Clinics for a year from the 1st of January 2018 to the 31st of December 2018. We then excluded patients with ejection fraction (EF) of >35% by examining the relevant patients' echocardiogram reports. Results: In Heart Failure Clinic in Hospital A (with an EP service), 172 patients attending the heart failure clinic had an EF less than or equal to 35%. Of those, 116 had an ICD (67.4%); 88 with an ICD and 28 with a Cardiac Resynchronisation Therapy – Defibrillator (CRT-D). 56 patients did not have ICD/CRT. In Hospital B (without an EP service), 174 patients attending the heart failure clinic had an EF less than or equal to 35%. 83 of these patients had an ICD (47.7%). Of those, 56 had an ICD and 27 had a CRT-D. We report a significant difference of 19.7% (p=0.0002) between two large tertiary referral centres in the rate of guideline-directed ICD implantation (figure 1). Conclusion: The availability of an electrophysiology service in a hospital may improve the rates of guideline-directed ICD implantation for heart failure with reduced ejection fraction. This hypothesis warrants further investigation in larger studies.