Sadarmin Praveen P, Wong Kelvin C K, Rajappan Kim, Bashir Yaver, Betts Timothy R
Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom.
Pacing Clin Electrophysiol. 2012 Jun;35(6):672-80. doi: 10.1111/j.1540-8159.2012.03373.x. Epub 2012 Mar 27.
There are little data on cardiologists' knowledge and application of current implantable cardioverter defibrillator (ICD) guidelines, attitudes to risk, and how these may influence ICD prescription.
A questionnaire survey was sent to UK cardiologists to test their knowledge and application of ICD guidelines and their estimate of the clinical benefits gained in different clinical scenarios. They were questioned on the minimum absolute risk reduction (ARR) required to justify an ICD implant and factors that influenced their decision making.
Sixty responses from 23 implanters and 37 nonimplanters were obtained. Eighty-three percent implanters and 43% nonimplanters were fully aware of UK ICD National Institute of Clinical Excellence guidelines. Only 7% responders had a screening program to identify primary prevention (PP) candidates. Although the mean estimate of ARR in PP scenarios was similar to trial data, the range of estimates was very wide. The benefit in secondary prevention (SP) scenarios was overestimated by both implanters and nonimplanters. Three-year ARR believed to justify PP and SP ICDs were heavily influenced by patients' age but in patients <80 years, age was compatible with trial results. Implanters and nonimplanters correctly applied guidelines in SP scenarios with younger patients but often withheld an ICD in elderly patients. Correct application did not correlate with full awareness of guidelines.
Lack of knowledge of guidelines (particularly in nonimplanters), failure of nonimplanters to offer ICDs to appropriate PP patients, age bias, and a lack of screening programs appear to be the greatest barriers to uptake of ICDs in the United Kingdom, rather than financial concerns.
关于心脏病专家对当前植入式心脏复律除颤器（ICD）指南的了解和应用、对风险的态度以及这些因素如何影响ICD处方的数据很少。
向英国心脏病专家发送了一份问卷调查，以测试他们对ICD指南的了解和应用，以及他们对不同临床场景中获得的临床益处的估计。询问他们植入ICD所需的最小绝对风险降低（ARR）以及影响他们决策的因素。
获得了来自23名植入者和37名非植入者的60份回复。83%的植入者和43%的非植入者完全了解英国ICD国家临床优化研究所指南。只有7%的受访者有筛查计划来识别一级预防（PP）候选人。虽然PP场景中ARR的平均估计与试验数据相似，但估计范围非常广泛。植入者和非植入者都高估了二级预防（SP）场景中的益处。认为可证明PP和SP ICD合理的三年ARR受到患者年龄的严重影响，但在<80岁的患者中，年龄与试验结果相符。植入者和非植入者在年轻患者的SP场景中正确应用了指南，但在老年患者中往往不植入ICD。正确应用与对指南的充分了解无关。
缺乏对指南的了解（特别是在非植入者中）、非植入者未向合适的PP患者提供ICD、年龄偏见以及缺乏筛查计划似乎是英国采用ICD的最大障碍，而非经济问题。
