Key result
Among patients with HFrEF, the subcutaneous ICD was associated with significantly better positive appraisal compared to the transvenous ICD (score 88 vs 81; P=0.02) at 12 months.
Why the study?
Although the S-ICD is an effective alternative to transvenous ICDs, no study had compared them by assessing patient acceptance as a patient-centered outcome.
Does the subcutaneous implantable cardioverter-defibrillator (S-ICD) improve patient acceptance compared to transvenous ICD in patients with HFrEF?
Observational (n=176)
Yes
Does the subcutaneous implantable cardioverter-defibrillator (S-ICD) improve patient acceptance compared to transvenous ICD in patients with HFrEF?
Absolute Event Rate: 88% vs 81%
p-value: p=0.02
The S-ICD is well-accepted by patients and may offer better positive appraisal than transvenous ICDs in patients with HFrEF.
Patient acceptance data in HFrEF should not yet guide device choice; leaves open need for randomized S-ICD versus transvenous comparisons.
BACKGROUND: The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an effective alternative to the transvenous ICD. No study has yet compared S-ICD and transvenous ICD by assessing patient acceptance as a patient-centered outcome. OBJECTIVE: To evaluate the patient acceptance of the S-ICD and to investigate its association with clinical and implantation variables. In patients with symptomatic heart failure and reduced ejection fraction (HFrEF), the acceptance of the S-ICD was compared with a control group of patients who received a transvenous ICD. METHODS: Patient acceptance was calculated with the Florida Patient Acceptance Survey (FPAS) which measures four factors: return to function (RTF), device-related distress (DRD), positive appraisal (PA), and body image concerns (BIC). The survey was administered 12 months after implantation. RESULTS: 176 patients underwent S-ICD implantation. The total FPAS and the single factors did not differ according to gender, body habitus, or generator positioning. Patients with HFrEF had lower FPAS and RTF. Younger patients showed better RTF (75 [56-94] vs. 56 [50-81], p = .029). Patients who experienced device complications or device therapies showed higher DRD (40 [35-60] vs. 25 [10-50], p = .019). Patients with HFrEF receiving the S-ICD had comparable FPAS, RTF, DRD, and BIC to HFrEF patients implanted with the transvenous ICD while exhibited significantly better PA (88 [75-100] vs. 81 [63-94], p = .02). CONCLUSIONS: Our analysis revealed positive patient acceptance of the S-ICD, even in groups at risk of more distress such as women or patients with thinner body habitus, and regardless of the generator positioning. Among patients receiving ICDs for HFrEF, S-ICD was associated with better PA versus transvenous ICD.
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Vicentini et al. (2021) conducted an observational in Heart failure with reduced ejection fraction (HFrEF) and ICD indication (n=176). Subcutaneous implantable cardioverter-defibrillator (S-ICD) vs. Transvenous ICD was evaluated on Positive appraisal (PA) score on the Florida Patient Acceptance Survey (FPAS) in HFrEF patients (p=0.02). Among patients with HFrEF, the subcutaneous ICD was associated with significantly better positive appraisal compared to the transvenous ICD (score 88 vs 81; P=0.02) at 12 months.
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