132 Could an increased focus on heart failure medications post icd/crt-d implant for primary prevention of sudden cardiac death reduce device therapy rates?

Abstract

<h3>Introduction</h3> Implantation of an ICD or CRT-D device can provide lifesaving treatment of ventricular arrhythmias. This benefit, while enormous to any individual receiving therapy from their device, is offset by the risk of device related complications and costs to the healthcare system. The 2016 DANISH study has raised questions about the benefits provided by primary prevention ICD/CRT-D devices, particularly in in the setting of non-ischaemic cardiomyopathy. We chose to investigate the frequency of successful treatment of ventricular arrhythmia in our population of patients with such devices in situ. <h3>Methods</h3> We included all patients under the care of the cardiology team at the Royal Edward Albert Infirmary in Wigan with an ICD or CRT-D device implanted between September 2015 and January 2020. We excluded all patients with a secondary prevention indication for device implantation and patients with conditions for which specific guidelines for device implantation exist, such as hypertrophic and arrhythmogenic cardiomyopathy. We reviewed the device programming reports from the date of insertion to 1st March 2021 to record any device therapy delivered, excluding any inappropriate therapy. We collected relevant demographic and clinical data from our electronic patient record system. <h3>Results</h3> We included 170 patients in our study. The mean time with a device in situ was 3.5 years. 165 (97.1%) of patients had echocardiographic evidence of severe left ventricular systolic dysfunction (ejection fraction ≤35%). 32 (18.8%) of patients received appropriate and successful anti-tachycardia pacing or cardioversion / defibrillation. 86 (50.6%) of patients had a diagnosis of ischaemic cardiomyopathy; 84 (49.4%) had a non-ischaemic heart failure aetiology. Of the patients that received device therapy 16 (50.0%) were diagnosed with ischaemic cardiomyopathy and 16 (50.0%) had a non-ischaemic diagnosis. When reviewing patient records 21.8% (37) had up to date documentation of heart failure medications and doses. <h3>Conclusion</h3> Our data shows that a significant proportion of our patients are having ventricular arrhythmias successfully terminated by their ICD/CRT-D devices. This applies to patients with both ischaemic and non-ischaemic cardiomyopathy. These data support the continued implantation of ICD and CRT-D devices for primary prevention of sudden cardiac death in patients with severe left ventricular dysfunction and can help guide decision making for patients and clinicians. A key finding was the low level of documentation and discussion of heart failure medications in patients post ICD implant. The ESC guidelines are clear regarding the requirement for optimal medical therapy prior to ICD/CRT-D implant. We note the relatively high rate of ICD/CRT-D therapy in our patient population and are planning further work to investigate whether a continued focus on optimisation of medications post implant, including the addition of newer agents, may reduce rates of device therapy. <h3>Conflict of Interest</h3> Nil