Department of Cardiology, Erasmus MC, Rotterdam, PO Box 2040, 3000, CA, the Netherlands.
Neth Heart J. 2011 Oct;19(10):405-11. doi: 10.1007/s12471-011-0176-3.
The benefit of implantable defibrillators (ICDs) for primary prevention remains debated. We analysed the implications of prophylactic ICD implantation according to the guidelines in 2 tertiary hospitals, and made a healthcare utilisation inventory.
The cohort consisted of all consecutive patients with coronary artery disease (CAD) or dilated cardiomyopathy (DCM) receiving a primary prophylactic ICD in a contemporary setting (2004-2008). Follow-up was obtained from hospital databases, and mortality checked at the civil registry. Additional data came from questionnaires sent to general practitioners.
There were no demographic differences between the 2 centres; one had proportionally more CAD patients and more resynchronisation therapy (CRT-D). The 587 patients were followed over a median of 28 months, and 50 (8.5%) patients died. Appropriate ICD intervention occurred in 123 patients (21%). There was a small difference in intervention-free survival between the 2 centres. The questionnaires revealed 338 hospital admissions in 52% of the responders. Device-related admissions happened on 68 occasions, in 49/276 responders. The most frequently reported ICD-related admission was due to shocks (20/49 patients); for other cardiac problems it was mainly heart failure (52/99). Additional outpatient visits occurred in 19%.
Over a median follow-up of 2 years, one fifth of prophylactic ICD patients receive appropriate interventions. A substantial group undergoes readmission and additional visits. The high number of admissions points to a very ill population. Overall mortality was 8.5%. The 2 centres employed a similar procedure with respect to patient selection. One centre used more CRT-D, and observed more appropriate ICD interventions.
植入式心脏除颤器（ICD）在一级预防中的获益仍存在争议。我们分析了根据 2 家三级医院的指南进行预防性 ICD 植入的影响，并制作了一份医疗资源利用清单。
该队列由在当代环境下（2004-2008 年）接受一级预防性 ICD 的所有连续冠状动脉疾病（CAD）或扩张型心肌病（DCM）患者组成。通过医院数据库获得随访信息，并在公民登记处检查死亡率。额外的数据来自发送给全科医生的调查问卷。
2 家中心之间没有人口统计学差异；一家中心的 CAD 患者比例更高，且接受心脏再同步治疗（CRT-D）的患者更多。587 例患者的中位随访时间为 28 个月，有 50 例（8.5%）患者死亡。123 例（21%）患者发生了适当的 ICD 干预。2 家中心的无干预生存存在微小差异。调查问卷显示，52%的应答者中有 338 例住院。设备相关的住院共发生 68 次，在 49/276 名应答者中。报告最频繁的 ICD 相关住院原因是电击（49 例患者中的 20 例）；对于其他心脏问题，主要是心力衰竭（99 例患者中的 52 例）。另外还发生了 19%的门诊就诊。
在中位随访 2 年期间，五分之一的预防性 ICD 患者接受了适当的干预。相当一部分患者需要再次住院和额外就诊。高比例的住院人数表明患者病情严重。总死亡率为 8.5%。2 家中心在患者选择方面采用了类似的程序。一家中心使用了更多的 CRT-D，并观察到更多适当的 ICD 干预。
