Key result
Failing to refer LVEF ≤35% patients to EP leaves ~56% without primary prevention ICD assessment.
Why the study?
What are the barriers to primary prevention ICD implantation in eligible patients with severe LV systolic dysfunction?
Observational (n=326)
No
What are the barriers to primary prevention ICD implantation in eligible patients with severe LV systolic dysfunction?
The primary reason for low primary prevention ICD implant rates in the UK is the failure to refer eligible patients from general physicians to cardiologists and from cardiologists to electrophysiologists.
Referral gaps may underlie underuse of primary prevention ICDs; leaves open whether targeted referral interventions improve implantation rates.
AIMS: Primary prevention (PP) implantable cardioverter defibrillator (ICD) implant rates in the UK are below national targets and barriers to this are not well known. This study was designed to identify the stages along the referral pathway from general to specialist care that eligible patients reach and what proportion eventually receive an ICD. METHODS AND RESULTS: A single institution database search was performed to identify all adults with severe left ventricular systolic dysfunction (left ventricular ejection fraction, LVEF≤35%), documented in the calendar year 2007. Medical records were assessed for age, heart failure aetiology, QRS duration, evidence of non-sustained ventricular tachycardia on Holter, electrophysiological study, and records of consultation with general physicians, cardiologists, and electrophysiologists (EPs) and reference to assessment of risk of sudden cardiac death and the role of ICD implantation. Three hundred twenty-six patients with LVEF ≤ 35% were identified from three electronic databases. Mean age was 72 ± 12 years. Seventy-two patients satisfied UK National Institute for Clinical Excellence guidelines for PP ICD implantation and 63 eligible for further screening. Of the 135 patients, 76 (56%) patients reviewed by a general cardiologist did not receive ICD implantation or referral for further assessment. When offered, ICD acceptance rate was high (35 vs. 3 patients who refused ICD). After seeing an EP, 8 of 47 (17%) patients were not offered ICD or further screening. The average age was 66.5 ± 6.2 years and no patient greater than 80 years had a PP ICD. CONCLUSIONS: Failure to refer from the general physician to cardiology and from the cardiologist to EP is the principle reason for low PP ICD implant rates among eligible patients in the UK.
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Sadarmin et al. (2014) conducted an observational in Severe left ventricular systolic dysfunction (n=326). Primary prevention ICD referral pathway was evaluated on Proportion of eligible patients receiving an ICD or referral for further assessment. Failure to refer eligible patients with LVEF ≤35% from general cardiology to electrophysiology resulted in 56% (76 of 135) not receiving a primary prevention ICD or further assessment.
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