Primary Prevention of Sudden Cardiac Death in Asia

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Risk of sudden cardiac death in ischemic and nonischemic cardiomyopathy. Intervention: Implantable cardioverter-defibrillator (ICD) for primary prevention vs. Optimal medical therapy. Primary outcome: Sudden cardiac death and all-cause mortality.

Q: What does this research mean for the field?

Implantable cardioverter-defibrillators reduce all-cause mortality by 23% to 54% in ischemic cardiomyopathy, yet remain markedly underutilized across Asia. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chu‐Pak Lau; Hung‐Fat Tse

doi:10.1016/j.jacasi.2023.04.006

June 1, 2023JACC AsiaOpen Access

Primary Prevention of Sudden Cardiac Death in Asia

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Graphical abstract published by JACC Asia — Graphical abstract · Published by JACC Asia · CC BY-NC-ND

Why the study?

Does primary prevention implantable cardioverter-defibrillator (ICD) therapy reduce sudden cardiac death and all-cause mortality in Asian patients with cardiomyopathy, and what factors drive its underutilization in Asia?

Key Points

To review the regional epidemiology of sudden cardiac death in Asia and evaluate clinical evidence, guideline recommendations, and barriers to implantable cardioverter-defibrillator therapy.
Expert commentary synthesizing international guideline recommendations, meta-analyses, and randomized clinical trial outcomes in ischemic and nonischemic cardiomyopathy.
Evaluation of observational registries and clinical studies reporting sudden cardiac death incidence and device utilization rates across Asian and Western countries.
Reported sudden cardiac death rates are 30 to 45 per 100,000 person-years in China, Japan, and South Korea, compared with 50 to 100 per 100,000 person-years in the United States and Europe.
Defibrillator use is markedly lower in Asia; in the PARADIGM-HF trial, devices were used in 54% of North American patients versus 1.7% of Asia-Pacific patients.
Registry data from the Improve SCA study revealed patient refusal was driven by inability to pay (53.8%) and disbelief in device benefits (19.4%), with out-of-pocket costs exceeding 45% in several lower-income nations.

Structured PICO

Does primary prevention implantable cardioverter-defibrillator (ICD) therapy reduce sudden cardiac death and all-cause mortality in Asian patients with cardiomyopathy, and what factors drive its underutilization in Asia?

P

Population

Asian patients with ischemic or nonischemic cardiomyopathy at risk for sudden cardiac death.

I

Intervention

Implantable cardioverter-defibrillator (ICD) implantation for primary prevention of sudden cardiac death on top of optimal medical therapy (OMT)

C

Comparator

Optimal medical therapy (OMT) alone, or Western/North American and European cohorts in epidemiological and utilization comparisons

O

Outcome

Sudden cardiac death (SCD) and all-cause mortalityhard clinical

Limitations

Paucity of accurate data on the incidence of sudden cardiac death in many countries in Asia
Most randomized trials cited for ICD efficacy are more than 10 years old with few Asian individuals included
Improvements in modern heart failure medical therapies may decrease the relative impact of ICDs on total mortality
Paucity of accurate data on incidence of SCD in many countries in Asia
Most cited primary prevention ICD trials are more than 10 years old with few Asian participants
Recent improvements in heart failure medical therapies (e.g., SGLT2 inhibitors, neprilysin inhibitors) decrease the overall impact of ICDs on total mortality

Implication

This editorial highlights that while primary prevention ICDs remain effective for reducing sudden cardiac death in Asian patients with cardiomyopathy, profound regional disparities, socioeconomic barriers, and evolving medical therapies necessitate better risk stratification and Asian-specific cohort data.

Abstract

[Figure: see text]

Discussion

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Cite This Study

Lau et al. (2023) conducted an editorial in Risk of sudden cardiac death in ischemic and nonischemic cardiomyopathy. Implantable cardioverter-defibrillator (ICD) for primary prevention vs. Optimal medical therapy was evaluated on Sudden cardiac death and all-cause mortality.

synapsesocial.com/papers/6a739537007d73ca2ffb68da https://doi.org/10.1016/j.jacasi.2023.04.006

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Primary Prevention of Sudden Cardiac Death in Asia

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Primary Prevention of Sudden Cardiac Death in Asia

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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