Key result
A survey of UK cardiologists revealed that 83% of implanters and 43% of nonimplanters were fully aware of ICD guidelines, highlighting knowledge gaps and age bias as key barriers to ICD uptake.
Cross-Sectional (n=60)
Yes
Absolute Event Rate: 83% vs 43%
Significant barriers to appropriate ICD uptake in the UK include a lack of guideline knowledge among nonimplanters, age bias, and the absence of screening programs.
Knowledge gaps and age bias may limit UK ICD uptake; leaves open whether education or screening programs improve appropriate implantation rates.
INTRODUCTION: There are little data on cardiologists' knowledge and application of current implantable cardioverter defibrillator (ICD) guidelines, attitudes to risk, and how these may influence ICD prescription. METHODS: A questionnaire survey was sent to UK cardiologists to test their knowledge and application of ICD guidelines and their estimate of the clinical benefits gained in different clinical scenarios. They were questioned on the minimum absolute risk reduction (ARR) required to justify an ICD implant and factors that influenced their decision making. RESULTS: Sixty responses from 23 implanters and 37 nonimplanters were obtained. Eighty-three percent implanters and 43% nonimplanters were fully aware of UK ICD National Institute of Clinical Excellence guidelines. Only 7% responders had a screening program to identify primary prevention (PP) candidates. Although the mean estimate of ARR in PP scenarios was similar to trial data, the range of estimates was very wide. The benefit in secondary prevention (SP) scenarios was overestimated by both implanters and nonimplanters. Three-year ARR believed to justify PP and SP ICDs were heavily influenced by patients' age but in patients <80 years, age was compatible with trial results. Implanters and nonimplanters correctly applied guidelines in SP scenarios with younger patients but often withheld an ICD in elderly patients. Correct application did not correlate with full awareness of guidelines. CONCLUSION: Lack of knowledge of guidelines (particularly in nonimplanters), failure of nonimplanters to offer ICDs to appropriate PP patients, age bias, and a lack of screening programs appear to be the greatest barriers to uptake of ICDs in the United Kingdom, rather than financial concerns.
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Sadarmin et al. (2012) conducted a cross-sectional in Knowledge and application of ICD guidelines (n=60). Questionnaire survey vs. Implanters vs nonimplanters was evaluated on Full awareness of UK ICD National Institute of Clinical Excellence guidelines. A survey of UK cardiologists revealed that 83% of implanters and 43% of nonimplanters were fully aware of ICD guidelines, highlighting knowledge gaps and age bias as key barriers to ICD uptake.
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