The impact of wearable cardioverter-defibrillator use on long-term decision for implantation of a cardioverter-defibrillator in a semirural acute care hospital

Anil-Martin Sinha,Jens Bense,Wolfgang Hohenforst-Schmidt

doi:10.1007/s10840-020-00898-5

Abstract

PurposeLarge-scale multi-center studies have reported on efficacy of the wearable cardioverter-defibrillator (WCD). However, outcomes focused on WCD patients treated at community-based acute care centers are lacking.MethodsPatients with cardiomyopathy were included when left ventricular ejection fraction (LVEF) at baseline was ≤ 35%. There were 120 patients meeting the criteria who also had LVEF measured at baseline and after 90 days of WCD use.ResultsAfter 90 days of WCD use, there were 44 (37%) patients in whom LVEF improved to > 35%. Comparison of patients, by whether LVEF improved or not, indicated that median days of WCD wear and hours of daily use were similar as well as characteristics, such as gender, age, and starting LVEF; and diagnoses leading to WCD prescription were similar between groups as were symptom-based prescription of medications. At the end of WCD use, improved LVEF > 35% correlated with fewer implantable cardioverter-defibrillator (ICD) implants. There were 4 (3%) episodes of new atrial fibrillation detected during WCD use. The WCD appropriately delivered a shock to 3 (2.5%) patients with VT/VF being terminated by the first shock. All shocked patients survived for at least 24 h post-shock.ConclusionsDuring WCD use, ischemic and non-ischemic cardiomyopathy patients manifest improved LVEF by 90 days. Long-term care decisions, such as implantation of an ICD, were influenced by LVEF improvement and occurrence of spontaneous VT/VF. The WCD protected patients from sudden cardiac death (SCD) until patient response to guideline-directed medical therapy could be determined.

Highlights

Outside the hospital, acute care is dependent on access to emergency medical services (EMS)
wearable cardioverterdefibrillator (WCD) prescription was based upon standard clinical algorithm performed at the Sana Klinikum in Hof, Germany (Fig. 1)
Eligible patients diagnosed with acute myocardial infarction (MI) were prescribed the WCD for 3 months when percutaneous coronary intervention (PCI) was performed or for 40 days without revascularization

Summary

Introduction

Acute care is dependent on access to emergency medical services (EMS). Automated defibrillators placed in the home have been unsuccessful when measured against improved survival following VT/VF [4]. The Vest Prevention of Early Sudden Death Trial (VEST) failed to achieve statistical significance for sudden cardiac death (SCD) reduction at 90 days [5], multi-center registries and prospective studies have provided convincing evidence that patients benefit from wearable cardioverterdefibrillator (WCD) use [6, 7]. Feldman et al found in 289 patients at high risk for sudden death that a WCD was beneficial in detecting and effectively treating ventricular tachyarrhythmias in patients at high risk for sudden death who were not clear candidates for an implantable cardioverterdefibrillator (ICD) [8]. The WCD seemed to be useful as a bridge to transplantation or ICD in selected patients [8]

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Discussion

Conclusion