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Consideration for primary prevention implantable cardioverter defibrillators differ between specialities
  1. Amar Mistry1,2,
  2. Zakariyya Vali1,2,
  3. Abu Taher2,
  4. Bharat Sidhu1,
  5. Xin Li1,
  6. Michelle Newton1,
  7. Ghulam Andre Ng1,2
  1. 1 Department of Cardiovascular Science, University of Leicester, Leicester, UK
  2. 2 Department of Cardiology, Glenfield Hospital, Leicester, UK
  1. Correspondence to Amar Mistry, Department of Cardiovascular Science, University of Leicester, Leicester, UK; amarmistry{at}nhs.net

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.

  • implantable cardioverter-defibrillator
  • left ventricular systolic impairment
  • sudden cardiac death prevention

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Footnotes

  • Contributors All authors have read and approved this work. Each author has contributed significantly to the work. AM was responsible for planning the study, reviewing the literature, conducting the data collection and writing the manuscript. ZV and AT were responsible for conducting the data collection and writing the manuscript. BS contributed to the data collection. XL, MN and GAN contributed to the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the institution’s review board. According to the UK Health Research Authority’s decision algorithm, the study would not be classified as research requiring formal research ethics committee review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.