Implementation of guidelines for implantable cardioverter-defibrillator therapy in clinical practice: Which patients do benefit?

Abstract

PurposeBased on multiple large clinical trials conducted over the last decades guidelines for implantable cardioverter-defibrillator (ICD) implantations have been evolving. The increase in primary prophylactic ICD implantations challenges us to be critical towards the indications in certain patient populations.MethodsWe retrospectively collected patient characteristics and rates of appropriate and inappropriate ICD therapy, appropriate and inappropriate ICD shock and mortality of all patients who received an ICD in the University Medical Center Utrecht (UMCU) over the years 2006–2011.ResultsA total of 1075 patients were included in this analysis (74 % male, mean age 61 ± 13 years, left ventricular ejection fraction 30 ± 13 %); 61 % had a primary indication and 58 % had ischaemic heart disease. During a mean follow-up period of 31 ± 17 months, 227 of the patients (21 %) received appropriate ICD therapy (149 (14 %) patients received an appropriate ICD shock). Females, patients with a primary prophylactic indication and patients with non-ischaemic heart disease experienced significantly less ICD therapy. Only a few patients (54, 5 %) received inappropriate ICD therapy; 33 (3 %) patients received an inappropriate ICD shock. Fifty-five patients died within one year after ICD implantation and were therefore, in retrospect, not eligible for ICD implantation.ConclusionOur study confirms the benefit of ICD implantation in clinical practice. Nevertheless, certain patients experience less benefit than others. A more patient-tailored risk stratification based on electrophysiological parameters would be lucrative to improve clinical benefit and cost-effectiveness.

Remote monitoring of implantable cardioverter defibrillators: Patient experiences and preferences for follow‐up

“…Patients who are at high risk for life‐threatening ventricular arrhythmias are preferably treated with an implantable cardioverter defibrillator (ICD). The number of ICD patients has increased due to expanding indications, leading to higher workload and increased healthcare costs . Remote patient monitoring (RPM) systems can send disease‐ and ICD‐related data from the patient's home to the hospital, and are, therefore, a promising alternative to in‐clinic follow‐up …”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

“…Several studies have shown male sex as an independent risk factor for appropriate ICD therapies 438 . Women are 30%‐50% less likely to receive an appropriate shock, 439–442 and this difference is more pronounced among CRT‐D recipients 443–445 . However, most of studies have shown similar mortality rates in both genders after ICD implantation 438–445 .…”

Patient perspective on remote monitoring of cardiovascular implantable electronic devices: rationale and design of the REMOTE-CIED study

“…Given the growth in the number of patients receiving a cardiovascular implantable electronic device (CIED), in particular the implantable cardioverter defibrillator (ICD) and cardiac resynchronisation therapy (CRT) devices, the burden on outpatient clinics to follow up these patients is increasing [ 1 – 3 ]. Remote patient monitoring offers a potential solution to this problem [ 4 ].…”