AIMS: This study surveyed referring clinicians to identify barriers that may contribute to New Zealand's low national implantable cardioverter defibrillator (ICD) implant rate. METHODS: We conducted a telephone survey of 100 cardiologists and general physicians working at 30 different New Zealand hospitals who routinely manage patients with ischaemic heart disease and heart failure. RESULTS: The majority of those surveyed (76%) rated their knowledge as satisfactory or better, although only 62% reported familiarity with international guidelines for ICD therapy. When asked to identify ICD indications 80% identified symptomatic or sustained ventricular arrhythmias and 73% left ventricular dysfunction. While 82% believed that the use of ICD therapy for secondary prevention was cost effective, only 53% believed they were cost effective for primary prevention. Lack of financial resource (88%), lack of local expertise (61%), lack of New Zealand guidelines (51%), and the referral process (43%) were seen as significant barriers to ICD referral by many participants. The majority of rural clinicians (71%) identified restricted access to investigations as a barrier to implantation, significantly higher than urban clinicians (18%, P = 0.001). CONCLUSION: We have identified a number of potential barriers that will need to be addressed to raise the New Zealand ICD implantation rate.
AIMS: This study surveyed referring clinicians to identify barriers that may contribute to New Zealand's low national implantable cardioverter defibrillator (ICD) implant rate. METHODS: We conducted a telephone survey of 100 cardiologists and general physicians working at 30 different New Zealand hospitals who routinely manage patients with ischaemic heart disease and heart failure. RESULTS: The majority of those surveyed (76%) rated their knowledge as satisfactory or better, although only 62% reported familiarity with international guidelines for ICD therapy. When asked to identify ICD indications 80% identified symptomatic or sustained ventricular arrhythmias and 73% left ventricular dysfunction. While 82% believed that the use of ICD therapy for secondary prevention was cost effective, only 53% believed they were cost effective for primary prevention. Lack of financial resource (88%), lack of local expertise (61%), lack of New Zealand guidelines (51%), and the referral process (43%) were seen as significant barriers to ICD referral by many participants. The majority of rural clinicians (71%) identified restricted access to investigations as a barrier to implantation, significantly higher than urban clinicians (18%, P = 0.001). CONCLUSION: We have identified a number of potential barriers that will need to be addressed to raise the New Zealand ICD implantation rate.
Authors: Jorge M Castellanos; Lisa M Smith; Paul D Varosy; Christine Dehlendorf; Gregory M Marcus Journal: Heart Rhythm Date: 2012-02-02 Impact factor: 6.343
Authors: Hisham Dokainish; Lauren Jewett; Robby Nieuwlaat; Joshua Coulson; Catherine Demers; Eva Lonn; Jeff Healey; Brian Haynes; Stuart Connolly Journal: Open Cardiovasc Med J Date: 2014-09-30