Knowledge Gaps in Implantable Cardioverter Defibrillator Therapy: a Survey of Trainees in Internal Medicine and Cardiology

Abstract

Background: Knowledge of clinical practice guidelines for Implantable Cardioverter Defibrillator (ICD) therapy is a pre-requisite for effective application of this life-saving technology. The level of trainee familiarity with these guidelines is unknown. The objective of this study was to assess trainee familiarity with clinical practice guidelines for ICD therapy. Methods: This study surveyed 32 clinicians of varying training levels in internal medicine and cardiology at a large VA medical center. This is a survey study conducted from a population of all trainees in internal medicine at the medical center; the sample included trainees from PGY-1 through PGY-7 as well as attending physicians in internal medicine. Analysis of the collected survey data was performed using either Chi-square tests for comparison of categorical variables or unpaired t-tests for comparison of means. Results: Of all respondents, 69% reported that they were familiar with published guidelines, and consistent with previously published data. Cardiologists were significantly more likely to report familiarity than internists (85% vs 42%, P=0.01). Most respondents (75%) reported satisfactory or better knowledge of published guidelines, though only 34% self-reported their knowledge as good or very good. The majority of respondents (86%) underestimated the usual cost of ICD implantation, while most respondents (78%) agreed that implantation of an ICD was cost-effective for secondary prevention, cardiologists were far more likely to agree than internists (95% vs. 50%, P<0.03). Conclusion: There are considerable knowledge gaps evident among trainees with regard to clinical practice guidelines for ICD therapy. This likely represents a modifiable barrier to ICD implantation. Structured education for medical trainees on the appropriate use and referral practices consistent with practice guidelines may reduce knowledge gaps and increase appropriate ICD implantation. Keywords: IMPLANTABLE CARDIOVERTER DEFIBRILLATORS, SURVEY, TRAINING, CLINICAL PRACTICE GUIDELINES