Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries: Clinical characteristics and reasons for implantation refusal

Zhang, Shu; Ching, Chi Keong; Huang, Dejia; Liu, Yen‐Bin; Rodríguez, Diego; Hussin, Azlan; Kim, Young Hoon; Chasnoits, Alexandr Robertovich; Cerkvenik, Jeffrey; Muckala, Katy; Cheng, Alan

doi:10.1111/pace.13526

Cited by 13 publications

(17 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Avoidance of fluoroscopy may contribute to reducing the economical barrier that precludes extensive device implantation in developing countries. In a multinational study seeking to determine reasons for cardiac implant refusal, inability to pay for the procedure was cited as the most common reason for implant refusal 15 …”

Section: Discussionmentioning

confidence: 99%

Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

Sogade

Aben

Eyituoyo

et al. 2021

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Background Permanent cardiac implantable electronic devices (CIEDs) are traditionally implanted with the assistance of fluoroscopy. While clinically effective, this technique exposes both patients and providers to radiation which is associated with adverse health effects and represents an occupational hazard. In this study, we investigate the safety and feasibility of permanent CIED placement under the guidance of transthoracic echocardiography (TTE). There is also increasing interest in use of non‐fluoroscopic options for noninvasive cardiac electrophysiologic procedures. Methods Fifteen patients consecutively consented for initial implant of CIEDs, specifically dual chamber pacemakers (DCPM) and dual chamber implantable cardioverter defibrillators (DCICDs). Patients were excluded if they had previous implants, abandoned leads, or anatomic anomalies including congenital and known persistent left superior vena cava (PLSVC). We used TTE to guide and implant atrial and ventricular leads. Results Eleven patients received DCPMs and four patients received DCICDs. The procedure duration was 49.3 min for DCICD and 52.3 min for DCPM, p = .807. The average number of right atrial lead attempts was 1.6 for DCPMs and 1.8 for DCICD, p = .860. The average number of right ventricular lead attempts for DCPMs was 2.2 and 1.0 attempt for DCICDs, p = .044. There were no complications at 90‐day follow‐up. Conclusion We demonstrate the feasibility of TTE‐guided DCPM/DCICD implantation without use of fluoroscopy. We present this method as a safe alternative for permanent CIED placement that may reduce risk of radiation exposure and cost while maintaining safety and efficacy. No operators wore lead aprons during the procedure.

show abstract

Section: Discussionmentioning

confidence: 99%

Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

Sogade

Aben

Eyituoyo

et al. 2021

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…34 The Improve SCA study found the main reasons to be financial, reimbursement issues, and not believing in the benefits of the therapy. 35 A recent study in Turkey found that only one-third of eligible chronic HF patients receive a…”

Section: Adherence To Icd Therapy Effect On Mortalitymentioning

confidence: 99%

The mortality analysis of primary prevention patients receiving a cardiac resynchronization defibrillator (CRT‐D) or implantable cardioverter‐defibrillator (ICD) according to guideline indications in the improve SCA study

Ching

Hsieh

Liu

et al. 2021

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

Background: In primary prevention (PP) patients the utilization of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapydefibrillators (CRT-D) remains low in many geographies, despite the proven mortality benefit. Purpose: The objective of this analysis was to examine the mortality benefit in PP patients by guideline-indicated device type: ICD and CRT-D. Methods: Improve sudden cardiac arrest was a prospective, nonrandomized, nonblinded multicenter trial that enrolled patients from regions where ICD utilization is low. PP patient's CRT-D or ICD eligibility was based upon the 2008 ACC/AHA/HRS and 2006 ESC guidelines. Mortality was assessed according to guideline-indicated device type comparing implanted and nonimplanted patients. Cox proportional hazards methods were used, adjusting for known factors affecting mortality risk. Results: Among 2618 PP patients followed for a mean of 20.8 ± 10.8 months, 1073 were indicated for a CRT-D, and 1545 were indicated for an ICD. PP CRT-Dindicated patients who received CRT-D therapy had a 58% risk reduction in mortality compared with those without implant (adjusted hazard ratio [HR]: 0.42, 95% confidence interval [

show abstract

“…The reasons for refusal were documented for patients who chose not to undergo implantation, and patients could select multiple reasons. 17 Patient follow-ups were completed in person or by telephone every 6 months postimplantation or postrefusal until study closure. Patients with SP indications who did not receive an implant were exited, as they would not contribute to the objectives of the study.…”

Section: Follow-up and Data Collectionmentioning

confidence: 99%

Utilization of implantable cardioverter-defibrillators for the prevention of sudden cardiac death in emerging countries: Improve SCA clinical trial

et al. 2020

Self Cite

View full text Add to dashboard Cite

BACKGROUND Implantable cardioverter-defibrillators (ICDs) are underutilized in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA Study is the largest prospective study to evaluate the benefit of ICD therapy in underrepresented geographies. This analysis reports the primary objective of the study. OBJECTIVES The objectives of this study was to determine whether patients with primary prevention (PP) indications with specific risk factors (1.5PP: syncope, nonsustained ventricular tachycardia, premature ventricular contractions .10/h, and low ventricular ejection fraction ,25%) are at a similar risk of life-threatening arrhythmias as patients with secondary prevention (SP) indications and to evaluate all-cause mortality rates in 1.5PP patients with and without devices. METHODS A total of 3889 patients were included in the analysis to evaluate ventricular tachycardia or fibrillation therapy and mortality rates. Patients were stratified as SP (n 5 1193) and patients with PP indications. The PP cohort was divided into 1.5PP patients (n 5 1913) and those without any 1.5PP criteria (n 5 783). The decision to undergo ICD implantation was left to the patient and/ or physician. The Cox proportional hazards model was used to compute hazard ratios. RESULTS Patients had predominantly nonischemic cardiomyopathy. The rate of ventricular tachycardia or fibrillation in 1.5PP patients was not equivalent (within 30%) to that in patients with SP indications (hazard ratio 0.47; 95% confidence interval 0.38-0.57) but was higher than that in PP patients without any 1.5PP criteria (hazard ratio 0.67; 95% confidence interval 0.46-0.97) (P 5 .03). There was a 49% relative risk reduction in all-cause mortality in ICD implanted 1.5PP patients. In addition, the number needed to treat to save 1 life over 3 years was 10.0 in the 1.5PP cohort vs 40.0 in PP patients without any 1.5PP criteria. CONCLUSION These data corroborate the mortality benefit of ICD therapy and support extension to a selected PP population from underrepresented geographies.

show abstract

Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries: Clinical characteristics and reasons for implantation refusal

Cited by 13 publications

References 16 publications

Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

Feasibility study for echocardiography‐guided lead insertion for permanent cardiac implantable electronic devices

The mortality analysis of primary prevention patients receiving a cardiac resynchronization defibrillator (CRT‐D) or implantable cardioverter‐defibrillator (ICD) according to guideline indications in the improve SCA study

Utilization of implantable cardioverter-defibrillators for the prevention of sudden cardiac death in emerging countries: Improve SCA clinical trial

Contact Info

Product

Resources

About