Consideration for primary prevention implantable cardioverter defibrillators differ between specialities. Issue 1122 (16th May 2019)

• Record Type: Journal Article
• Authors: Mistry, Amar; Vali, Zakariyya; Taher, Abu; Sidhu, Bharat; Li, Xin; Newton, Michelle; Ng, Ghulam Andre
• Is Part Of: Postgraduate medical journal. Volume 95:Issue 1122(2019)
• Page Start: 205
• Page End: 209
• Publication Date: 2019-05-16
• Subjects: implantable cardioverter-defibrillator -- left ventricular systolic impairment -- sudden cardiac death prevention; Medicine -- Periodicals; 610
• DOI: 10.1136/postgradmedj-2019-136447
• Languages: English
• ISSNs: 0032-5473

Abstract

Abstract: Purpose: Implantable cardioverter defibrillator (ICD) implantation rates remain variable despite established guideline recommendations. This study aims to assess whether being managed by a cardiologist has an impact on whether patients are considered for an ICD for primary prevention of sudden cardiac death. Design/Methods: Single-centre, retrospective, observational study of patients identified to have severe left ventricular systolic dysfunction (LVSD) on echocardiography (n = 129) between 1 and 30 June 2016 with cross-sectional assessment at 1 year. An assessment of ICD consideration at 1 year following the echocardiogram was documented, in addition to the specialty of the managing physician (group 1—electrophysiologist/heart failure specialist; group 2—all other cardiologists; group 3—non-cardiologist). Results: 129/1173 (11%) transthoracic echocardiographies (s) were identified to have severe LVSD. 52 (40%), 37 (29%) and 40 (31%) were managed by group 1, group 2 and group 3, respectively. Mean age was 74.7 (±12.6) years with a predominance of male gender (70.5%). An ICD was not considered in 47.3%. Those managed by a cardiologist were more likely to be considered for an ICD than a non-cardiologist (63.9% vs 30.0%; OR 4.0, 95% CI 1.8 to 8.8, p = 0.001) with a greater survival at 1 year (89.9% vs 52.5%, OR 8.1 95% CI 3.2 to 20.4, p < 0.001). Group 1 were more likely to consider ICD than group 2 cardiologists (75.0% vs 45.9%; OR 3.5; 95% CI 1.4 to 8.7, p = 0.005). Conclusion: There is significant variation between cardiologists and non-cardiologists, as well as within different cardiology subspecialists, when considering the option of ICD therapy for primary prevention.