Incidence Screening for Primary Prevention ICDs
Incidence Screening for Primary Prevention ICDs
We conducted an observational study within a cardiology tertiary centre with the aim of increasing the primary prevention implantable cardioverter defibrillator (ICD) implantation rate in line with Heart Rhythm UK (HRUK) national target.
A total of 326 patients experienced ST-elevation myocardial infarction (STEMI) over a 14-month time period and were offered incidence screening for implantation of a primary prevention ICD at six weeks according to National Institute for Health and Clinical Excellence (NICE) guidelines (TA095). There were 273 (84%) patients who completed the screening process; 26 (8%) had an ejection fraction (EF) of <35%. Two patients had an EF of <30% with a QRS duration >120 msec. Two of 22 subjects had evidence of non-sustained ventricular tachycardia on 24-hour Holter monitoring; one had a positive ventricular tachycardia stimulation test. Overall, three patients received an ICD (0.9%).
In conclusion, this process was labour intensive and had a lower than expected yield.
The implantable cardioverter defibrillator (ICD) implant rate within the UK remains significantly lower than that across Europe; furthermore, there is marked inequity in access to ICD implant between regions within the UK. The need for an ICD is self-evident in secondary prevention patients successfully resuscitated from ventricular tachycardia (VT) or ventricular fibrillation (VF). Intuitively, therefore, it would seem most likely that underperformance and inequity of access in the UK resides chiefly within the primary prevention patient group. A number of international randomised-controlled trials have identified patient subgroups at an increased risk of arrhythmic death for whom implantation of a primary prevention ICD carries a prognostic benefit. On the basis of these, the National Institute for Health and Clinical Excellence (NICE) has made recommendations on patient groups for whom ICD implantation should routinely be considered on prognostic grounds. Appendix-C of the NICE guidance document makes recommendations for audit to determine whether clinicians are in compliance with NICE guidance. In this paper we report the yield from incidence screening on a cohort of patients at six weeks following ST-elevation myocardial infarction (STEMI).
Abstract and Introduction
Abstract
We conducted an observational study within a cardiology tertiary centre with the aim of increasing the primary prevention implantable cardioverter defibrillator (ICD) implantation rate in line with Heart Rhythm UK (HRUK) national target.
A total of 326 patients experienced ST-elevation myocardial infarction (STEMI) over a 14-month time period and were offered incidence screening for implantation of a primary prevention ICD at six weeks according to National Institute for Health and Clinical Excellence (NICE) guidelines (TA095). There were 273 (84%) patients who completed the screening process; 26 (8%) had an ejection fraction (EF) of <35%. Two patients had an EF of <30% with a QRS duration >120 msec. Two of 22 subjects had evidence of non-sustained ventricular tachycardia on 24-hour Holter monitoring; one had a positive ventricular tachycardia stimulation test. Overall, three patients received an ICD (0.9%).
In conclusion, this process was labour intensive and had a lower than expected yield.
Introduction
The implantable cardioverter defibrillator (ICD) implant rate within the UK remains significantly lower than that across Europe; furthermore, there is marked inequity in access to ICD implant between regions within the UK. The need for an ICD is self-evident in secondary prevention patients successfully resuscitated from ventricular tachycardia (VT) or ventricular fibrillation (VF). Intuitively, therefore, it would seem most likely that underperformance and inequity of access in the UK resides chiefly within the primary prevention patient group. A number of international randomised-controlled trials have identified patient subgroups at an increased risk of arrhythmic death for whom implantation of a primary prevention ICD carries a prognostic benefit. On the basis of these, the National Institute for Health and Clinical Excellence (NICE) has made recommendations on patient groups for whom ICD implantation should routinely be considered on prognostic grounds. Appendix-C of the NICE guidance document makes recommendations for audit to determine whether clinicians are in compliance with NICE guidance. In this paper we report the yield from incidence screening on a cohort of patients at six weeks following ST-elevation myocardial infarction (STEMI).
