Utilization of Primary Prevention ICDs in a Population Based Cohort Is Associated with a Significant Survival Benefit.
Circ Arrhythm Electrophysiol. 2012 Jun 8;
Authors: Parkash R, Sapp JL, Basta M, Doucette S, Thompson K, Gardner M, Gray C, Brownell B, Kidwai H, Cox J
BACKGROUND: -Under-utilization of implantable defibrillators has been previously noted in patients at risk for sudden cardiac death, as well as survivors of sudden cardiac death. We sought to determine utilization rates in a primary prevention ICD-eligible population and mortality in this group as compared to a group who had undergone implantation of this therapy. METHODS AND RESULTS: -A retrospective cohort of patients from April 1, 2006 until December 31, 2009 was used to define a primary-prevention ICD-eligible population. Two groups were compared based on ICD implantation (No ICD vs ICD). The primary outcome measure was mortality. Of 717 patients found to be potentially eligible for a primary prevention ICD, 116 (16%) were referred. The remaining cohort of 601 patients were compared to an existing cohort of primary prevention ICD patients (n=290). A significant survival benefit was associated with primary prevention ICD implantation (HR 0.46, 95%CI (0.33, 0.64), p<0.0001). When adjusted for prespecified variables known to be associated with overall mortality and propensity score, a similar survival benefit was seen (HR0.59, 95% CI(0.40, 0.87) p=0.01). Appropriate ICD therapy occurred in 26% of those in the ICD group, over a mean follow-up of 2.7 years. CONCLUSIONS: -A significant mortality benefit was observed for patients who underwent primary prevention ICD implantation compared to those who did not. Vigilance is required to ensure that patients eligible for primary prevention ICDs are appropriately referred and assessed to allow such patients to benefit from this life-saving therapy.
PMID: 22685111 [PubMed - as supplied by publisher]