Key result
ICD implantation reaches only ~29% of eligible OHCA survivors within 30 days of discharge.
Why the study?
Despite established benefits and guideline recommendations for ICD therapy in OHCA survivors, few studies have described the proportion of patients receiving guideline-concordant care.
What is the rate of guideline-concordant ICD implantation in potentially eligible out-of-hospital cardiac arrest survivors?
Observational (n=10,435)
Yes
What is the rate of guideline-concordant ICD implantation in potentially eligible out-of-hospital cardiac arrest survivors?
Answers are grounded in this paper and cite their sources.
Despite an increasing trend, there remains significant underutilization of ICDs for secondary prevention in eligible out-of-hospital cardiac arrest survivors in Canada.
Abstract Background Patients resuscitated from out-of-hospital cardiac arrest (OHCA) are at high risk of recurrence, posing a substantial burden on healthcare systems. Despite the established benefit of implantable cardioverter defibrillator (ICD) therapy in many such patients, and recommendations by guidelines, few studies have described the proportion of OHCA patients who receive guideline-concordant care. Methods The Canadian Institute for Health Information Discharge Abstract Database dataset was used to identify OHCA patients admitted to hospitals across Canada, excluding Quebec. We analyzed all patients without a probable ischemic or bradycardia etiology of cardiac arrest, who survived to discharge, to estimate the ICD implantation rates in patients who were potentially eligible to have an ICD. Results Between 2013 and 2017, a total of 10,435 OHCA patients who were admitted to the hospital were captured in the database; 4486 (43%) survived to hospital discharge, and 2580 survivors (57.5%) were potentially eligible to receive an ICD. Among these potentially eligible patients, 757 (29.3%) received an ICD during their index admission or within 30 days after discharge from the hospital. The ICD implantation rate during index admission increased from 13.8% in 2013 to 19.6% in 2017 (P-value for time trend < 0.05). The rate of ICD implantations in potentially eligible patients was higher in urban than in rural settings (19.5% vs 11.1%) and in teaching vs community hospitals (34.7% vs 9.8%). Conclusions Although ICD implantation rates show an increasing trend among patients with OHCA who are likely eligible for secondary prevention, significant underutilization of ICDs persists in these patients.
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Darabi et al. (2023) conducted an observational in Out-of-hospital cardiac arrest (OHCA) (n=10,435). Implantable cardioverter defibrillator (ICD) was evaluated on ICD implantation during index admission or within 30 days after discharge. ICD implantation was performed in only 29.3% of potentially eligible out-of-hospital cardiac arrest survivors within 30 days of discharge, demonstrating significant underutilization.
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