A POPULATION-BASED STUDY OF ADHERENCE TO APPROPRIATE USE CRITERIA AND GUIDELINE RECOMMENDATIONS FOR IMPLANTABLE CARDIOVERTER DEFIBRILLATORS

Abstract

Guidelines exist to help physicians identify patients who would benefit from implantable cardioverter defibrillator (ICD) therapy however limited data exists regarding physician adherence to guideline recommendations. Therefore, the aims of this study were to determine the proportion of patients receiving ICD therapy according appropriate use criteria and guideline recommendations and to identify reasons for non-adherence to appropriate use criteria. We performed a retrospective review of all ICDs implanted from January 1, 2015- December 31, 2016 in Edmonton, Alberta. Patients were evaluated by an electrophysiologist and a consensus decision to implant was made during a formal peer review process. We classified implants according to the 2013 Appropriate Use Criteria for ICDs and CRT, 2008 ACC/AHA/HRS ICD guidelines, 2012 ACCF/AHA HRS Focused Update and the 2013 CCS CRT guidelines. A total of 897 devices were implanted (22 implants were excluded due to missing information, n=875). Baseline characteristics are shown in Table I. The mean age was 63 ±13; 82% were male; mean ejection fraction of 0.31 ±0.13 and 62% of implants were for primary prevention. Of the procedures performed, 64% were new implants, 29% were generator changes, and 10% were upgrades. The majority of ICD implants met ‘appropriate’ (91%) and class I indications (70%) while no procedures had a class III indications (Figure 1). Non-adherence to appropriate use criteria was demonstrated in 14% (n=48) of implants. Reasons for non-adherence included no existing appropriate use criteria (n=32, 67%), recent revascularization (n=8, 17%), research participation (n=4, 8%) and recent myocardial infarction (n=4, 8%). In this population-based study, we found that our formal process of specialist evaluation and peer-reviewed consensus was highly effective at achieving consistency with appropriate use criteria and guideline-derived recommendations.View Large Image Figure ViewerDownload Hi-res image Download (PPT)