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Implantable cardioverter defibrillator therapy for primary prevention of sudden cardiac death after myocardial infarction: implications of international guidelines.

Foley, Paul W X and Addison, Clara E and Whinney, Stephanie B and Patel, Kiran and Cunningham, David and Frenneaux, Michael P and Leyva, Francisco (2009) Implantable cardioverter defibrillator therapy for primary prevention of sudden cardiac death after myocardial infarction: implications of international guidelines. Pacing and clinical electrophysiology : PACE, 32 Sup. S131-4. ISSN 1540-8159. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1540-...

Abstract

STUDY OBJECTIVE

To estimate the proportion of patients eligible for implantable cardioverter defibrillator (ICD) therapy for the primary prevention of sudden cardiac death after a myocardial infarction (MI), according to the current guidelines.

METHODS

Eligibility was assessed retrospectively at 6 weeks in 513 post-MI survivors (age 66 +/- 13 years, left ventricular ejection fraction 48.2 +/- 17%) on the basis of an electrocardiogram and an echocardiogram.

RESULTS

LVEF was < or = 40% in 37% and < or = 35% in 30%, and QRS duration was <120 ms in 89% and > or =120 ms in 11% of patients. The proportion of post-MI patients meeting the criteria set by guidelines were 37% for 2006 American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) 26.5% for 2008 ACC/AHA/Canadian Heart Rhythm Society 16.3% for 2005 US Centers for Medicare and Medicaid Services (CMS), and 5.8% for the 2006 United Kingdom (UK) National Institute of Clinical Excellence (NICE). According to 2005 CMS and 2006 UK-NICE guidelines, Holter monitoring was required in 7% and 18%, respectively. For the United States (700,000 MI in 2006), the 2006 ACC/AHA/ESC guidelines equate to 216,783 ICD implantations/year. For UK (60,499 MI in 2006), the 2006 NICE guidelines equate to 2,941 ICD implantations, 10,488 Holter studies, and 1,065 VT induction tests/year.

CONCLUSIONS

Current ICD therapy guidelines for primary prevention of SCD post-MI demand a substantial increase in service provision worldwide.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
Divisions: Emergency Services > Cardiology
Related URLs:
Depositing User: Sophie Rollason
Date Deposited: 10 Jun 2014 13:29
Last Modified: 10 Jun 2014 13:29
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/148

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