Praveen P Sadarmin1, Kelvin Ck Wong1, Kim Rajappan1, Yaver Bashir1, Timothy R Betts2. 1. Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford OX3 9DU, UK. 2. Department of Cardiology, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Headington, Oxford OX3 9DU, UK ep.doctors@ouh.nhs.uk.
Abstract
AIMS: Primary prevention (PP) implantable cardioverter defibrillator (ICD) implant rates in the UK are below national targets and barriers to this are not well known. This study was designed to identify the stages along the referral pathway from general to specialist care that eligible patients reach and what proportion eventually receive an ICD. METHODS AND RESULTS: A single institution database search was performed to identify all adults with severe left ventricular systolic dysfunction (left ventricular ejection fraction, LVEF≤35%), documented in the calendar year 2007. Medical records were assessed for age, heart failure aetiology, QRS duration, evidence of non-sustained ventricular tachycardia on Holter, electrophysiological study, and records of consultation with general physicians, cardiologists, and electrophysiologists (EPs) and reference to assessment of risk of sudden cardiac death and the role of ICD implantation. Three hundred twenty-six patients with LVEF ≤ 35% were identified from three electronic databases. Mean age was 72 ± 12 years. Seventy-two patients satisfied UK National Institute for Clinical Excellence guidelines for PP ICD implantation and 63 eligible for further screening. Of the 135 patients, 76 (56%) patients reviewed by a general cardiologist did not receive ICD implantation or referral for further assessment. When offered, ICD acceptance rate was high (35 vs. 3 patients who refused ICD). After seeing an EP, 8 of 47 (17%) patients were not offered ICD or further screening. The average age was 66.5 ± 6.2 years and no patient greater than 80 years had a PP ICD. CONCLUSIONS: Failure to refer from the general physician to cardiology and from the cardiologist to EP is the principle reason for low PP ICD implant rates among eligible patients in the UK. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Primary prevention (PP) implantable cardioverter defibrillator (ICD) implant rates in the UK are below national targets and barriers to this are not well known. This study was designed to identify the stages along the referral pathway from general to specialist care that eligible patients reach and what proportion eventually receive an ICD. METHODS AND RESULTS: A single institution database search was performed to identify all adults with severe left ventricular systolic dysfunction (left ventricular ejection fraction, LVEF≤35%), documented in the calendar year 2007. Medical records were assessed for age, heart failure aetiology, QRS duration, evidence of non-sustained ventricular tachycardia on Holter, electrophysiological study, and records of consultation with general physicians, cardiologists, and electrophysiologists (EPs) and reference to assessment of risk of sudden cardiac death and the role of ICD implantation. Three hundred twenty-six patients with LVEF ≤ 35% were identified from three electronic databases. Mean age was 72 ± 12 years. Seventy-two patients satisfied UK National Institute for Clinical Excellence guidelines for PP ICD implantation and 63 eligible for further screening. Of the 135 patients, 76 (56%) patients reviewed by a general cardiologist did not receive ICD implantation or referral for further assessment. When offered, ICD acceptance rate was high (35 vs. 3 patients who refused ICD). After seeing an EP, 8 of 47 (17%) patients were not offered ICD or further screening. The average age was 66.5 ± 6.2 years and no patient greater than 80 years had a PP ICD. CONCLUSIONS: Failure to refer from the general physician to cardiology and from the cardiologist to EP is the principle reason for low PP ICD implant rates among eligible patients in the UK. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Stephen B Wilton; Matthew T Bennett; Ratika Parkash; Katherine Kavanagh; E Marc Jolicoeur; Frank Halperin; Umjeet Jolly; Peter Leong-Sit; Rozsa Sas; Derek S Chew; Sarah Singh; Stephanie Frisbee; Robert MacLachlan; Jaimie Manlucu Journal: JAMA Netw Open Date: 2021-12-01