Improving ICD Guideline Utilization in a Community Based Cardiology Practice

Abstract

Introduction: ACC/AHA guidelines have established implantable cardioverter defibrillator (ICD) therapy as a Class I guideline for preventing sudden cardiac arrest. In our 11 person cardiology practice, the use of ICDs decreased by 29% in 2006 versus 2005, while the number of patients seen remained stable. We sought to understand the impact of a simple quality improvement plan to increase identification of patients at risk for sudden cardiac arrest. Methods: We initiated a manual chart review of cardiac catheterization patients from the previous 3 years, and standardized discharge plans for coronary artery disease patients who were Post-MI, Post CABG, or Post PCI (Table 1). Practice staff and physicians were educated on current ICD guidelines. The monthly ICD implant rates for the 6 months following these steps were compared with the monthly implant rates in 2006.Tabled 1Post-MI-sheduled day of dischargePost CABG/PCI-scheduled day of dischargeEchocardiogram −6 weeksEchocardiogram −3 monthsStress Nuclear −6 weeksOptional Stress test −3 monthsOffice visit immediately after aboveOffice visit with PA/CNP −6 weeksOffice visit with physician −3 months Open table in a new tab Results: 6000 cardiac catheterization patient charts were reviewed. 311 (5.1%) nonimplanted patients met guideline criteria for ICD, varying from 5 to 61 patients per physician. Each physician received a list of their patients who met ICD criteria, but were not implanted. The ICD implant rate increased from 23/month in 2006 to 30/month (30% increase) in the 6 months following chart review and program initiation. Practice size and specialties within the practice remained constant. Conclusions: The implementation of standardized discharge plans by a community-based cardiology practice improves the delivery of quality care, potentially reducing variations in guideline adherence.