Clinical and Hospital Factors Affecting Treatment with Primary Prevention Implantable Cardioverter- Defibrillators in Ischemic Cardiomyopathy Patients
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Purpose: Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemiccardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantationrates and factors associated with appropriate PP ICD implants for ICM. Materials and Methods: In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who wereeligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital andclinical factors, were investigated. Results: Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0–78.0) years], only 76 (5.2%) patients underwentICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and totalhospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospitalsystem score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10–1.50] was an independent factor for predicting ICD implantation,along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97–17.87) andyounger age (<70 years: OR, 2.14; 95% CI, 1.30–3.53). Conclusion: PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICDimplantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantationrate (Clinical trial registration No. NCT03590925).
Abstract
Purpose: Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemiccardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantationrates and factors associated with appropriate PP ICD implants for ICM. Materials and Methods: In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who wereeligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital andclinical factors, were investigated. Results: Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0–78.0) years], only 76 (5.2%) patients underwentICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and totalhospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospitalsystem score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10–1.50] was an independent factor for predicting ICD implantation,along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97–17.87) andyounger age (<70 years: OR, 2.14; 95% CI, 1.30–3.53). Conclusion: PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICDimplantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantationrate (Clinical trial registration No. NCT03590925).
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