Key result
Systematic screening programs for sudden cardiac death operate in only ~61% of surveyed European centers.
Why the study?
Current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy across Europe was not well characterized.
What is the current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy across Europe?
Cross-Sectional (n=31)
Yes
What is the current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy across Europe?
The majority of participating European centres have a systematic screening programme for sudden cardiac death, relying primarily on clinical risk stratification for ICD candidate selection.
Variability in European SCD screening persists; leaves open whether test-based stratification improves ICD selection over clinical judgment alone.
The purpose of this EHRA survey was to examine the current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy with a focus on selection of candidates for implantable cardioverter-defibrillator (ICD) therapy, timing of ICD implantation, and use of non-invasive and invasive diagnostic tests across Europe. A systematic screening programme for sudden cardiac death existed in 19 out of 31 centres (61.3%). Implantation of ICDs according to the inclusion criteria of MADIT-II and SCD-HeFT trials was reported in 30 and 29% of centres, respectively, followed by MADIT-CRT (18%), COMPANION (16%), and combined MADIT and MUSTT (7%) indications. In patients with severe renal impairment, ICD implantation for primary prevention of sudden death was always avoided in 8 centres (33.3%), was not used only if creatinine level was >2.5 mg/dL in 10 centres (32.2%), and in patients with permanent dialysis in 8 centres (33.3%). Signal-averaged electrocardiography and heart rate variability were never considered as risk stratification tools in 23 centres (74.2%). Implantation of a loop recorder was performed in patients with borderline indications for ICD therapy in 6 centres (19.4%), for research purposes in 5 (16.1%), and was never performed in 20 (64.5%) centres. In conclusion, the majority of participating European centres have a screening programme for sudden cardiac death and the selection of candidates for ICD therapy was mainly based on the clinical risk stratification and not on non-invasive and invasive diagnostic tests or implantable loop recorder use.
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Proclemer et al. (2013) conducted a cross-sectional in ischaemic and non-ischaemic cardiomyopathy (n=31). Screening and risk evaluation practices was evaluated on Presence of a systematic screening programme for sudden cardiac death. A systematic screening programme for sudden cardiac death existed in 61.3% of 31 European centres, with ICD candidate selection based mainly on clinical risk stratification.
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