B-PO02-057 DEVICE NURSE-LED INTERVENTION TO INCREASE GUIDELINE-CONCORDANT PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PROGRAMMING

Abstract

Implantable cardioverter-defibrillators (ICDs) are highly effective in reducing mortality in patients at risk for life-threatening arrhythmias. However, studies have shown that delivery of unnecessary or inappropriate ICD therapies for non-sustained ventricular tachycardia and supraventricular tachycardia (SVT) is associated with increased morbidity and mortality. Thus, professional societies have issued guidelines on appropriate ICD programming for primary prevention of sudden cardiac death. We previously demonstrated that patients with primary prevention ICDs with guideline-concordant (GC) ICD programming had significantly lower ICD therapy rates compared to patients with guideline-discordant (GD) ICD programming. However, the rate of GC programming was very low. This study aims to assess the effect of a device nursing-led intervention on the rate of GC versus GD primary prevention ICD programming at one large academic center. A device nurse-led intervention was deployed in the cardiac device clinic at a large tertiary care center in January 2018. This intervention involved device nurse review of patients’ ICD programming at each clinic visit with alert of the covering electrophysiology provider if programming was GD. Consecutive patients undergoing primary prevention ICD implantation between 2018-2020 were assessed for rates of GC and NGC ICD programming. Kaplan-Meier analysis and Cox proportional hazard models were used to estimate freedom from first ICD therapy and shock. Comparisons were made to a control period before implementation of the intervention (consecutive patients with primary prevention ICD implantation between 2014-2016). A total of 241 patients underwent primary prevention ICD implementation during the study period. Of these, 215 (89.2%) had GC programming. Compared to the control period, rates of GC ICD programming significantly increased (31% of 310 patients versus 89.2% of 241 patients, respectively; p <0.01). A device nursing-led intervention successfully increased the rates of guideline-concordant primary prevention ICD programming at a large tertiary care center.