Implantable Cardioverter-defibrillator Implantation Rates Research Articles

Disparities in the implantation of secondary prevention implantable cardioverter defibrillator in the United States.

The annual incidence of sudden cardiac death is over 300,000 in the United States (US). Historically, inpatient implantation of secondary prevention implantable cardioverter defibrillator (ICD) has been variable and subject to healthcare disparities. To evaluate contemporary practice trends of inpatient secondary prevention ICD implants within the US on the basis of race, sex, and socioeconomic status (SES). The study is a retrospective analysis of the National Inpatient Sample from 2016 to 2020 of adult discharges with a primary diagnosis of ventricular tachycardia (VT), ventricular flutter, and fibrillation (VF). Adjusted ICD implantation rates based on race, sex, and SES and associated temporal trends were calculated using multivariate regression. A total of 193,600 primary VT/VF discharges in the NIS were included in the cohort, of which 57,895 (29.9%) had ICD placement. There was a significant racial and ethnic disparity in ICD placement for Black, Hispanic, Asian, and Native American patients as compared to White patients; adjusted odds ratio (aOR): 0.86 [p<.01], 0.90 [p = .03], 0.81[p<.01], 0.45 [p<.01], respectively. Female patients were also less likely to receive an ICD compared to male patients (aOR: 0.75, p<.01). Disparities in ICD placement remained stable over the study period (ptrend ≥.05 in all races, both sexes and income categories). Racial, sex, and SES disparities persisted for secondary prevention ICD implants in the US. An investigation into contributing factors and subsequent approaches are needed to address the modifiable causes of disparities in ICD implantation as these trends have not improved compared to historic data.

WEARABLE CARDIOVERTER DEFIBRILLATOR IN PATIENT WITH TRANSIENT RISK OF SUDDEN CARDIAC DEATH : SINGLE CENTRE EXPERIENCE

Abstract Background Cardiovascular disease is still the first cause of death, with sudden cardiac death ( SCD) as a first presentation in 25% of cases, related to coronary artery disease. Implantable cardioverter defibrillator (ICD) demontrated a reduction of SCD in high risk patients with good functional status. However the risk of SCD should be transient, so the use of a wearable cardioverter defibrillator (WCD) is considered in current guidelines and in clinical practice. The purpose of this study was to investigate the safety and the adherence to WCD in a real world population; moreover we reviewed the rate of ICD implantation after WCD use. Methods We considered consecutively 96 patients discharged from Piacenza cardiology department for potentially transient high risk of SCD, weared a WCD from August 2017 to June 2023. The patients were discharged in high risk mode of SCD with WCD protection and followed through remote monitoring or outpatient.A clinical and echocardiographic evalutation was performed at baseline and repeated at the end of the WCD use period. Results Out of 95 patients , with average age 66,0 ±11,1 years old and baseline average left ventricular ejection fraction (LVEF) 28,6±7,5, 81,2% were males, 72,9% suffered from arterial hypertension, 26% diabetes mellitus, 13,5% peripheral vascular disease, 14,6% chronic renal failure, 4,1% previous stroke.66% of these patients weared WCD for severe systolic disfunction in ischemic cardiac disease after recent myocardial infarction, after percutaneous coronary intervention or coronary artery bypass graft, 4% after removal of an infected ICD, 6% whilst awaiting completion of diagnostic tests (chanalopathies/right arrhythmogenic ventricular cardiomyopathy), 24% newly diagnosed cardiomyopathy. The average wearing time of WCD was 22,7±3,1 hours daily. We received these events: 1 sustained ventricular tachicardia, 2 non sustained ventricular tachicardia, 5 atrial fibrillation with 3 T wave oversensing. One patient recedived inappropriate shock. One death was detected due to severe heart failure. After 56,0±37,8 days of average wearing time 52% of patients were scheduled for ICD implantation. Conclusions In our experience we may consider that WCD use is effective, safe and with a good adherence in all patients. The WCD allows saving resources preventing inapprpriate ICD implantation in patient with transient SCD risk.

Abstract 13746: Mental Health and Implantable Cardioverter Defibrillator Implantation in Black Patients at Risk for Sudden Cardiac Death

Introduction: Black patients with guideline indications for implantable cardioverter defibrillators (ICD) have lower rates of implantation compared to White patients. The Educational Videos to Address Racial Disparities in ICD Therapy Via Innovative Designs (VIVID) trial enrolled self-identified Black individuals with chronic systolic heart failure and studied the impact of a video-based decision-support tool on decisional quality and ICD implantation. Hypothesis: We hypothesized that depressive symptoms are associated with greater decisional conflict and lower rates of ICD implantation among study participants. Methods: Participants were administered the Patient Health Questionnaire-2 (PHQ-2) depression screen; and the 12-Item Short-Form Health Survey, from which we derived the Mental Component Summary-12 (MCS-12). A decisional conflict scale (DCS) adapted from the Ottawa framework for shared decision-making was used to assess decisional conflict associated with the decision for ICD implantation. An analysis of covariance was used to assess differences in DCS scores. Multivariable logistic regression was used to examine the association between mental health scores and ICD implantation at 90 days. Results: Among 306 included participants, 60 (19.6%) reported depressed mood and 142 (46.4%) reported anhedonia. Participants with the lowest MCS-12 scores (poorer mental health) had greater decisional conflict regarding ICD assent compared to those with the highest MCS-12 scores (adjusted mean difference in DCS score = 3.05 [95% CI: 0.32, 5.78]). By 90-day follow-up, 204 participants (66.6%) underwent ICD implantation. There was no significant association between either PHQ-2 score or MCS-12 score and ICD implantation. Conclusions: Depressed mood and anhedonia were prevalent among Black patients considering primary prevention ICD. Poorer mental health did not impact the likelihood of ICD implantation in this population.

Disparities in Referral and Utilization of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death.

Implantable cardioverter-defibrillators (ICDs) reduce mortality in patients with reduced left ventricular ejection fraction (LVEF). We investigated sex disparities in a contemporary Canadian population for utilization of primary prevention ICDs. This was a retrospective cohort study on patients with reduced LVEF admitted to hospitals from 2010 to 2020 in Nova Scotia (population= 971,935). There were 4406 patients eligible for ICDs: 3108 (71%) men and 1298 (29%) women. The mean follow-up time was 3.9 ± 3.0 years. Rates of coronary disease were similar between men and women (45.8% vs 44.0%; P= 0.28), but men had lower LVEF (26.6 ± 5.9% vs 27.2 ± 5.8%; P= 0.0017). The referral rate for ICD was 11% (n= 487), with 13% of men (n= 403) and 6.5% of women (n= 84) referred (P < 0.001). The ICD implantation rate in the population was 8% (n= 358), with 9.5% of men (n= 296) and 4.8% of women (n= 62) (P < 0.001) receiving the device. Men were more likely than women to receive an ICD (odds ratio 2.08, 95% confidence interval 1.61-2.70; P < 0.0001)). There was no significant difference in mortality between men and women (P= 0.2764). There was no significant difference in device therapies between men and women (43.8% vs 31.1%; P= 0.0685). A significant disparity exists in the utilization of primary prevention ICDs between men and women in a contemporary Canadian population.

P262 PREDICTORS OF ICD IMPLANTATION: THE ROLE OF THE WEARABLE CARDIOVERTER DEFIBRILLATOR

Abstract Background Previous studies established a role for the wearable cardioverter defibrillator (WCD) In patients with transient risk of sudden cardiac death ( SCD) . In clinical trials, nearly 40% of patients received implantable cardioverter–defibrillator (ICD) implantation at the end of WCD use. It’ unknown if WCD can be usefull in final ICD implantation indication. Objectives We aimed to describe the clinical predictors of ICD implantation rate at the end of WCD use in a real–world single center experience. Methods and results Between August 2017 and June 2022, 60 consecutive patients receiving a WCD at Piacenza Hospitals were retrospectively included in this analysis: : mean age 66.9±11.9 years, 56.6% with ischaemic cardiomyopathy, 38.3% with dilated cardiomyopathy, 5% after implantable cardioverter–defibrillator explant. A total of 34 participants (56.6%) received implantable cardioverter–defibrillator (ICD) implantation at the end of WCD use. We evaluated clinical features related to ICD implantation rate with Chi Square test and Student’s t test. Female sex was related with no ICD implantation ( ICD 5,9% vs no ICD 23,1%, p= 0,03), whilst Low ejection fraction at beginning of evaluation was related with ICD implantation ( ICD 27.1±9.3 vs no ICD 33.1±11.9, p=0,03). Although in our population there weren’t shock of WCD, the strongest clinical predictor was arrhythmic event recordered at WCD monitoring both non sustained ventricular tachicardia, sustained ventricular tachicardia and supraventricular tachicardia ( ICD 20 vs no ICD 0, p &amp;lt; 0,01). Age ( ICD 66.6±11.9 vs NO ICD 67.4±11.9, p=0,7) and etiology of cardiopathy both ischemic and non ischemic ( ICD 52% vs no ICD 53,8%, P=0.5) were not factors associated with ICD implantation. Conclusion In our study the rate of ICD implantation after wearing time of WCD is consistent but slightly major to European registries. Arrhythmic Event recordered at WCD monitoring is related with ICD implantation, so WCD, when it is used, may be a further help in final ICD implantation.

MP-453089-11 DIFFERENCES IN UTILIZATION OF PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER DEFIBRILLATORS IN ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY ACROSS NORTH AMERICA AND EUROPE

Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death (SCD) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), but differences in their utilization across North America and Europe are unknown. To identify cross-national differences in both utilization of primary prevention ICDs and survival free from ventricular arrhythmia (VA) in patients with ARVC. This was a retrospective analysis of ARVC patients without prior sustained VA enrolled in clinical registries in 11 countries throughout Europe and North America. Patients were classified according to whether they received treatment in North America or Europe. They were further stratified by their calculated 5-year VA risk (low: <10%/5y, intermediate: 10-25%/5y, high: >25%/5y) using the ARVC risk calculator (ARVCrisk.com). Differences in rates of ICD implantation and VA-free survival were assessed using the Kaplan-Meier method and log-rank testing. Differences in VA-free survival were also assessed in the subset of patients without ICD. 1,098 patients were followed for a median of 5.1 years, during which time 554 (50.5%) received a primary prevention ICD. Patients treated in Europe were more likely to be probands (61.5% vs 52.0%, p=0.002) and were diagnosed at older ages (42 vs. 32 years, p<0.001). Baseline 5-year VA risk was similar (19.5% vs 19.4, p-value 0.71). North Americans were twice as likely to receive primary prevention ICDs (13.6%/year vs. 6.4%/year, p<0.001) and had shorter times from diagnosis to ICD implantation (83 days vs. 243 days, p<0.001). Overall, 285 patients (25.9%) experienced a first sustained VA event. Rates of VA were higher in North Americans compared to Europeans (6.0%/year versus 4.2%/year, p<0.001); this increase was driven primarily by higher rates of appropriate ICD therapy in North Americans (70.7% vs 59.3% of events). In sub-analysis of patients without ICD, North Americans had higher rates of VA events than Europeans (3.4%/year vs 2.4%/year, p=0.01). When stratified by baseline VA risk, North Americans received significantly more ICDs at all risk strata despite similar rates of VA events in low and intermediate risk patients (Figure). North American ARVC patients were significantly more likely to receive primary prevention ICDs across all risk strata than their European counterparts. However, a lower rate of primary prevention ICD implantation in Europe was not associated with a higher rate of adverse VA outcomes.

480 ICD AFTER STEMI: WHEN AND HOW FREQUENTLY IS IMPLANTED AND WHICH IS THE RATE OF APPROPRIATE INTERVENTIONS

Abstract Background there are limited data of implantable-cardioverter-defibrillator (ICD) implantation after STEMI treated with primary percutaneous coronary intervention (pPCI). This study sought to evaluate when and how frequently is ICD implanted after STEMI, the rate of appropriate ICD-interventions, and the independent predictors of ICD implantation. Methods We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients data with those present in the Trieste ICD registry. Results 1805 consecutive patients treated with pPCI were analyzed. During a median follow-up of 6.7 (IQR 4.3-9.2) years, the probability of ICD implantation at 12 months was 2.3% (95%CI: 1.7-3.1) and it remained stable overtime (at 24 months: 2.5%, 95%CI 2.0-3.5 and at 36 months: 2.6%, 95%CI 2.3-3.8). Mean time before ICD implantation was 35.5 months (95%CI: 34.8-36) . 83.1% of implanted ICD were for primary prevention, and more than half (55%) were implanted in patients with ejection fraction (EF)&amp;gt;35% at the moment of STEMI discharge. During a median follow-up of 5.7 (IQR 3.3-8.3) years after ICD implantation, the probability of appropriate ICD intervention was 9% and 11% after 12 and 24 months respectively. In patients with EF&amp;gt;35% at STEMI discharge (median EF 43%; IQR 40-48), predictors of ICD implantation were male sex, anterior STEMI and troponin peak &amp;gt;100.000 ng/dl. Conclusions The rate of ICD implantation after pPCI is low, however the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantation at follow-up despite a non-severe EF at discharge after STEMI. Among these patients those with high troponin release deserve strict follow-up and full optimal medical treatment.

Inter-American Society of Cardiology (CIFACAH-ELECTROSIAC) and Latin-American Heart Rhythm Society (LAHRS): multidisciplinary review on the appropriate use of implantable cardiodefibrillator in heart failure with reduced ejection fraction

BackgroundOur main objective was to present a multidisciplinary review on the epidemiology of sudden cardiac death (SCD) and the tools that could be used to identify malignant ventricular arrhythmias (VAs) and to perform risk stratification. In addition, indications and contraindications for the use of implantable cardioverter defibrillator (ICD) in general and in special populations including the elderly and patients with chronic kidney disease (CKD) are also given.MethodsAn expert group from the Inter American Society of Cardiology (IASC), through their HF Council (CIFACAH) and Electrocardiology Council (ElectroSIAC), together with the Latin American Heart Rhythm Society (LAHRS), reviewed and discussed the literature regarding the appropriate use of an ICD in people with heart failure (HF) with reduced ejection fraction (HFpEF). Indications and contraindications for the use of ICD are presented in this multidisciplinary review.ResultsNumerous clinical studies have demonstrated the usefulness of ICD in both primary and secondary prevention of SCD in HFpEF. There are currently precise indications and contraindications for the use of these devices.ConclusionsIn some Latin American countries, a low rate of implantation is correlated with low incomes, but this is not the case for all Latin America. Determinants of the low rates of ICD implantation in many Latin American countries are still a matter of research. VA remains one of the most common causes of cardiovascular death associated with HFrEF and different tools are available for stratifying the risk of SCD in this population.

Underrepresentation of women in implantable cardioverter defibrillator trials

There are sex differences in the epidemiology and presentation of ventricular arrhythmias. Sudden cardiac death (SCD) is less common in women than in men. Women have been under-represented in implantable cardioverter defibrillator (ICD) trials evaluating the benefit of ICD therapy for primary and secondary prevention of SCD. Following ICD implantation, women are less likely to experience appropriate ICD therapy for ventricular arrhythmias, consistent with epidemiological findings of a lower rate of SCD in women. Sex differences in ICD implantation rates have also been noted for primary and secondary prevention of SCD in registries and large observational cohort studies. Reasons for these differences are unclear. Age and comorbidities at the time of presentation may be partially responsible, although sex bias, patient preference, or contribution of social determinants of health cannot be excluded. There are many unanswered questions regarding reasons for sex differences in ICD usage and under-representation of women in clinical device trials. Additional investigation is needed to better understand these differences to improve outcome of all patients who are at risk for sudden cardiac arrest.

Worldwide differences in primary prevention implantable cardioverter defibrillator utilization and outcomes in hypertrophic cardiomyopathy.

Risk stratification algorithms for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) and regional differences in clinical practice have evolved over time. We sought to compare primary prevention implantable cardioverter defibrillator (ICD) implantation rates and associated clinical outcomes in US vs. non-US tertiary HCM centres within the international Sarcomeric Human Cardiomyopathy Registry. We included patients with HCM enrolled from eight US sites (n = 2650) and five non-US (n = 2660) sites and used multivariable Cox-proportional hazards models to compare outcomes between sites. Primary prevention ICD implantation rates in US sites were two-fold higher than non-US sites (hazard ratio (HR) 2.27 [1.89-2.74]), including in individuals deemed at high 5-year SCD risk (≥6%) based on the HCM risk-SCD score (HR 3.27 [1.76-6.05]). US ICD recipients also had fewer traditional SCD risk factors. Among ICD recipients, rates of appropriate ICD therapy were significantly lower in US vs. non-US sites (HR 0.52 [0.28-0.97]). No significant difference was identified in the incidence of SCD/resuscitated cardiac arrest among non-recipients of ICDs in US vs. non-US sites (HR 1.21 [0.74-1.97]). Primary prevention ICDs are implanted more frequently in patients with HCM in US vs. non-US sites across the spectrum of SCD risk. There was a lower rate of appropriate ICD therapy in US sites, consistent with a lower-risk population, and no significant difference in SCD in US vs. non-US patients who did not receive an ICD. Further studies are needed to understand what drives malignant arrhythmias, optimize ICD allocation, and examine the impact of different ICD utilization strategies on long-term outcomes in HCM.

Sex differences in arrhythmic burden with the wearable cardioverter-defibrillator

Data on the arrhythmic burden of women at risk for sudden cardiac death are limited, especially in patients using the wearable cardioverter-defibrillator (WCD). We aimed to characterize WCD compliance, atrial and ventricular arrhythmic burden, and WCD outcomes by sex in patients enrolled in the Prospective Registry of Patients Using the Wearable Cardioverter Defibrillator (WEARIT-II U.S. Registry). In the WEARIT-II Registry, we stratified 2000 patients by sex into women (n = 598) and men (n = 1402). WCD wear time, ventricular and atrial arrhythmic events during WCD use, and implantable cardioverter-defibrillator (ICD) implantation rates at the end of WCD use were evaluated. The mean WCD wear time was similar in women and men (94 days vs 90 days; P = .145), with longer daily use in women (21.4 h/d vs 20.7 h/d; P = .001). Burden of ventricular tachycardia or ventricular fibrillation was higher in women, with 30 events per 100 patient-years compared with 18 events per 100 patient-years in men (P = .017), with similar findings for treated and non-treated ventricular tachycardia/ventricular fibrillation. Recurrent atrial arrhythmias/sustained ventricular tachycardia was also more frequent in women than in men (167 events per 100 patient-years vs 73 events per 100 patient-years; P=.042). However, ICD implantation rate at the end of WCD use was similar in both women and men (41% vs 39%; P = .448). In the WEARIT-II Registry, we have shown a higher burden of ventricular and atrial arrhythmic events in women than in men. ICD implantation rates at the end of WCD use were similar. Our findings warrant monitoring women at risk for sudden cardiac death who have a high burden of atrial and ventricular arrhythmias while using the WCD.

Abstract 16484: Primary Prevention Implantable Cardioverter Defibrillator Utilization for Hypertrophic Cardiomyopathy in US vs Non-US: Findings From the Share Registry

Introduction: Risk stratification for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) has evolved with notable differences in international practice trends and US vs European guidelines. Hypothesis: Utilization of primary prevention implantable cardioverter defibrillators (ICD) is higher in the US. Methods: We examined rates of primary prevention ICD implantation in 5,063 HCM patients in the international SHaRe registry from 2000 - 2020 (NUS=2,390; Nnon-US=2,673). Using multiple logistic regression we compared probability of ICD implantation for US vs non-US sites adjusting for standard SCD risk factors (Figure 1A). Interaction tests were performed to identify risk factors differentially associated with ICD implantation in US vs non-US sites after 2014 when the European Society of Cardiology (ESC) risk score was introduced. Results: The odds of ICD implantation were 3-fold higher in US sites [ORUS/non-US=3.11 (2.54 -3.81)] (Figure 1A). Odds remained similar after adjustment for ESC risk score [OR =3.17 (2.57 -3.91)]. Implantation rates were higher in the US throughout the study period with a notable drop in rates in both US and non-US sites after 2014 and a reduction in the magnitude of the difference in ICD utilization between US and non-US sites (ORUS/non-US (&lt;2014) =4.20 (3.05-5.78) vs. ORUS/non-US (≥2014)=2.55 (1.89-3.44); pinteraction&lt;0.001) (Figure 1B). Non-sustained ventricular tachycardia was a stronger predictor of ICD implantation in US sites [ORUS=4.9 (3.4-7.0) vs ORnon-US= 2.1 (1.2-3.6); pinteraction=0.005], whereas, left atrial diameter (&gt; 40 mm) was a stronger predictor in non-US sites [ORNon-US=2.9 (2.1-4.0) vs ORUS=1.3 (1-1.6); pinteraction &lt;0.001]. Conclusions: ICD utilization rates vary globally. In this study, primary prevention ICD utilization rates were 3-fold higher in the US despite adjustment for standard SCD risk factors. Further studies are needed to evaluate outcomes of these practice differences.

Abstract 16887: Utilization of Cardiovascular Procedures in Cardiac Amyloidosis

Background: Cardiac amyloidosis (CA) is characterized by restrictive cardiomyopathy, atrial and ventricular arrhythmias, as well as atrioventricular block. However, it is unclear whether the use of procedures to treat these specific complications are utilized at different rates during admissions for heart failure (HF) patients with and without CA. Hypothesis: Patients with HF and CA undergo invasive and noninvasive cardiac procedures at a higher rate than those with HF alone. Methods: The National Inpatient Sample database was queried to identify hospitalizations from 2003 to 2014 for patients ≥18 years old admitted with a diagnosis of HF with or without CA. Admissions with CA were propensity-score matched 5:1 with admissions for HF without CA. Procedures, including cardioversion, pacemaker implantations and implantable cardioverter-defibrillator (ICD) implantations were identified by ICD-9 procedure codes; other comorbidities were identified by ICD-9 diagnosis codes. Rates of procedural utilization, length of stay, total charges cleared and discharge disposition were compared between matched groups. Results: Over the 12 years considered, we matched 10,519 admissions with HF and CA to 52,595 admissions for HF without CA. When compared to HF patients with CA, the rates of cardioversion and ICD implantation were higher and the rates of pacemaker implantation were lower in the HF patients without CA (p&lt;0.001 all comparisons). Discharge disposition was more favorable in the cohort without CA (p&lt;0.001); in particular the cohort with CA had a much higher in-hospital mortality rate (9.5% compared to 6.2%) as well as a longer length of stay (p&lt;0.001). There was no difference in charges cleared between the two groups. Procedure use is depicted in the figure. Conclusions: Despite longer hospital stays and higher inpatient mortality, the rates of utilization of procedures, particularly cardioversion and ICD implantation, was lower among HF patients with CA.

Implantable Cardioverter Defibrillator Utilization and Mortality Among Patients ≥65 Years of Age With a Low Ejection Fraction After Coronary Revascularization

The purpose of this analysis was to assess implantable cardioverter-defibrillator (ICD) utilization and its association with mortality among patients ≥65 years of age after coronary revascularization. Patients in the National Cardiovascular Database Registry Chest Pain-Myocardial Infarction (MI) Registry who presented with MI from January 2, 2009 to December 31, 2016, had a left ventricular ejection fraction ≤35% and underwent in-hospital revascularization (10,014 percutaneous coronary intervention (PCI) and 1,647 coronary artery bypass grafting (CABG)) were linked with Medicare claims to determine rates of 1-year ICD implantation. The association between ICD implantation and 2-year mortality was assessed. Of 11,661 included patients, an ICD was implanted in 1,234 (10.6%) within 1 year of revascularization (1,063 (10.6%) PCI and 171 (10.4%) CABG). Among PCI-treated patients, in-hospital ventricular arrhythmia (adjusted hazard ratio [aHR] 1.60, 95% confidence interval [CI] 1.34 to 1.92), 2-week cardiology follow-up (aHR 1.48, 95% CI 1.29 to 1.70), readmission for heart failure (aHR 3.21, 95% CI 2.73 to 3.79), and readmission for MI (aHR 2.18, 95% CI 1.66 to 2.85) were positively associated with ICD implantation. Among CABG-treated patients, in-hospital ventricular arrhythmia (aHR 2.33, 95% CI 1.39 to 3.91), and heart failure readmission (aHR 3.14, 95% CI 1.96 to 5.04) were positively associated with ICD implantation. Women were less likely to receive an ICD, regardless of the revascularization strategy. ICD implantation was associated with lower 2-year all-cause mortality (aHR 0.74, 95% CI 0.63 to 0.86). In conclusion, only 1 in 10 Medicare patients with low ejection fraction received an ICD within 1 year after revascularization. Contact with the healthcare system after discharge was associated with higher likelihood of ICD implantation. ICD implantation was associated with lower mortality following revascularization for MI.

911Which patients are most likely to benefit from the wearable cardioverter-defibrillator? Findings from the Swiss WCD registry

Abstract OnBehalf Swiss WCD Registry Introduction The wearable cardioverter-defibrillator (WCD) has established itself as a temporary protection from sudden arrhythmogenic death in selected patients at risk. However, it is still of debate which patients and for what duration benefit from its use. Therefore, appropriate patient selection is key. Purpose: This study reports the results of the Swiss WCD registry with an emphasis on implantable cardioverter-defibrillator (ICD) implantation rate and ICD therapies. Methods We retrospectively reviewed the indications, baseline characteristics and administered therapies in patients prescribed a WCD at 12 participating centers rom 2014 until 2018 in Switzerland. Further data on medical therapy, WCD therapy adherence, and ICD implantation rates were collected. Results 456 patients were included in our study comprising of 66% of all Swiss patients prescribed a WCD in the examined time period. The mean age was 57 ±14 years, 18% were female and the mean ejection fraction (EF) was 32% ± 13. Indications for WCD use and appropriate shock rate are shown in the figure. Patients wore the WCD over a median of 58 days (range 1-455) with a median daily average wear-time of 22.6 hours (range 0.6-23.8). 17 appropriate therapies were administered by the WCD to a total of 12 patients leading to a therapy rate of 2.6% over a median wear-time of 16 days (range 2-79) and to a therapy rate of 3.9% in patients with ischemic cardiomyopathy (ICM) with an EF ≤35%. ICM with an EF ≤35% and bridging to ICD-implantation or heart transplantation as indication for WCD prescription were significantly associated with an appropriate therapy (p = 0.046 and 0.003, respectively). One patient with non-ischemic cardiomyopathy (NICM) received an appropriate therapy (0.8%). The mean EF in patients receiving an appropriate therapy by the WCD was also significantly lower (p = 0.04). No patient with wearing the WCD for congenital/inherited heart disease or risk stratification with an EF &amp;gt;35% had a therapy administered by the WCD. There were no inappropriate therapies during the investigated time period. After cessation of WCD use EF improved to 38% ±13; ultimately, 212 patients (46%) were implanted with an ICD. During a follow-up of 476 days (range 7-2347) 22 (9.8%) patients received an appropriate therapy by their ICD. Four of the 22 had prior appropriate therapy by the WCD. Conclusions ICM with severely reduced EF was the most common indication for WCD use leading to a high rate of appropriate therapy by the WCD. This, however, did not translate in a higher rate of appropriate ICD-therapies during follow-up in this subpopulation possibly due to significant improvements in their ejection fractions. Patients with NICM or congenital/inherited heart disease seldom had an appropriate therapy by the WCD. Abstract Figure. Indications for WCD use and therapy rate

Yazd Province of Iran ICD Registry for the Years 2014–2016

This study aimed to investigate the trends in the care of patients undergoing implantable cardioverter-defibrillator (ICD) implantation in our region and to analyze whether the quality of care is the same as the other centers or not? Adult patients with an indication for ICD implants were enrolled in our registry and followed over a 19-43-month period. The ICD implantation rate was 100/million per year. The mean age of patients treated with ICD was 62.36 (±12.93) years old and the majority of patients were men (77.6%). Most patients had ischemic heart failure (65.2%). Nearly half of the patients had NYHA class III (53.8%) and the mean of ejection fraction was 26.7 (±9.8%). ICDs were frequently implanted for primary prevention (71.9%). Single chamber ICDs (ICD-VR) were chosen in 25.2%, dual-chamber ICDs in 37.1% (ICD-DR) and biventricular ICDs (CRT-D) in 37.6%, respectively. Complications related to ICD implantation occurred in about 7.49% of all procedures. During follow-up period death occurred in 14.8% of our patients. Also, 13.3% of patients received ICD shock which was appropriate in 71% of patients. In comparison between our registry and NCDR registry, baseline patient characteristics and ICD type were almost the same, but the complication rate was higher. There is still a need to perform a large multicenter registry in our community to improve our knowledge in this Era.

Disparity in implantable cardioverter defibrillator therapy among minority South Asians in the United Kingdom

ObjectiveThere are large geographical differences in implantable cardioverter defibrillator (ICD) implantation rates for reasons not completely understood. In an increasingly multiethnic population, we sought out to investigate whether ethnicity influenced...

Clinical and Hospital Factors Affecting Treatment with Primary Prevention Implantable Cardioverter-Defibrillators in Ischemic Cardiomyopathy Patients.

PurposeImplantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemic cardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM.Materials and MethodsIn this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who were eligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital and clinical factors, were investigated.ResultsOf the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0–78.0) years], only 76 (5.2%) patients underwent ICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and total hospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospital system score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10–1.50] was an independent factor for predicting ICD implantation, along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97–17.87) and younger age (<70 years: OR, 2.14; 95% CI, 1.30–3.53).ConclusionPP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICD implantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantation rate (Clinical trial registration No. NCT03590925).

Trends in the use of implantable cardioverter-defibrillators for prevention of sudden cardiac arrest: A South Korean nationwide population-based study.

The benefits of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac arrest (SCA) are well established. However, a significant knowledge gap remains regarding current indications and utilization of ICDs in real-world settings in Asia. Patients who underwent ICD implantation in South Korea from 2007 to 2015 were identified using the Health Insurance Review and Assessment Service database. We investigated trends in use of ICD for the prevention of SCA. A total of 4649 ICDs were implanted during 9 years. ICDs were implanted in 1448 (31.2%) patients for primary prevention and in 3201 (68.8%) for secondary prevention. The proportion of ICDs for primary prevention increased from 6.1% in 2007 to 41.9% in 2015. Primary prevention was more frequent in older (≥40 years) recipients (34.4%vs. 14.6%, P<.0001). The rates of ICD implantation for primary prevention were highest for nonischemic dilated cardiomyopathy (55.1%) and lowest (9.7%) for inherited primary arrhythmia syndrome (IPAS). Our data showed a trend of progressively increasing rates of ICD implantation in Asia, especially for primary prevention of SCA. Primary prevention as an indication for ICD in patients with IPAS remained low.

IMPACT OF NEUROLOGICAL PERFORMANCE ON DEFIBRILLATOR IMPLANTATION RATES AND LONG-TERM MORTALITY IN SUDDEN CARDIAC ARREST SURVIVORS

Implantable cardioverter defibrillators (ICDs) are recommended for survivors of sudden cardiac arrest (SCA). We assessed the impact of neurological performance on ICD implantation rates and long-term mortality in SCA survivors. Consecutive SCA survivors (n=1,433) were included. We calculated