Pillarisetti Jayasree, Emert Martin, Biria Mazda, Chotia Rashaad, Guda Rajeshwer, Bommana Sudharani, Pimentel Rhea, Vacek James, Raghuveer Dendi, Berenbom Loren, Dawn Buddhadeb, Lakkireddy Dhanunjaya
Section of Electrophysiology, Division of Cardiovascular Medicine, KU Cardiovascular Research Institute, University of Kansas Hospital and Medical Center, Kansas City, KS 66193.
Indian Pacing Electrophysiol J. 2015 Apr 1;15(1):20-9. doi: 10.1016/S0972-6292(16)30838-5. eCollection 2015 Jan-Feb.
Despite ACC/AHA guidelines indicating implantable cardioverter defibrillator (ICD) as class I therapy for primary prevention of sudden cardiac death in patients with EF≤35%, ICD utilization rates in real world practice have been low.
To determine the rate of ICD implantation at a tertiary care academic center and to assess the reasons for under-utilization of the same.
Review of a prospectively collected database which included all patients diagnosed with an EF≤35% was performed to assess the rate of ICD implantation and mortality. Reasons for non-implantation of ICD were then assessed from detailed chart review.
A total of 707 patients (age 69.4 ± 14.1 years) with mean EF of 26±7% were analyzed. Only 28% (200/707) of patients had ICDs implanted. Mortality was lower in the group with ICD (25% vs 37%, p=0.004). When patients who either died or were lost to follow-up prior to 2005 were excluded, ICD utilization rate was still low at 37.6%. The most common reason for non-implantation of ICD was physicians not discussing this option with their patients. Patient refusal was the second most common reason.
ICD Implantation rates for primary prevention of SCD in patients with EF≤35% is low. Physician and patient education should be addressed to improve the utilization rates.
尽管美国心脏病学会/美国心脏协会（ACC/AHA）指南将植入式心脏复律除颤器（ICD）列为左心室射血分数（EF）≤35%的患者心脏性猝死一级预防的I类治疗方法，但在实际临床实践中，ICD的使用率一直较低。
确定一家三级医疗学术中心的ICD植入率，并评估其使用不足的原因。
回顾一个前瞻性收集的数据库，该数据库纳入了所有诊断为EF≤35%的患者，以评估ICD植入率和死亡率。然后通过详细的病历审查评估未植入ICD的原因。
共分析了707例患者（年龄69.4±14.1岁），平均EF为26±7%。只有28%（200/707）的患者植入了ICD。植入ICD的患者组死亡率较低（25%对37%，p = 0.004）。排除2005年前死亡或失访的患者后，ICD使用率仍低至37.6%。未植入ICD的最常见原因是医生未与患者讨论该选择。患者拒绝是第二常见原因。
EF≤35%的患者心脏性猝死一级预防的ICD植入率较低。应加强医生和患者教育以提高使用率。
