Bernier Rochelle, Ng Jessica, Tran Dat T, Lockwood Evan, Reyes Lucy, Cowan Karen, Fine Nowell M, Ezekowitz Justin, Exner Derek V, Raj Satish R, Sandhu Roopinder K
Mazankowski Alberta Heart Institute, University of Alberta, Division of Cardiology, Edmonton, Alberta, Canada.
Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
CJC Open. 2019 Jun 7;1(4):173-181. doi: 10.1016/j.cjco.2019.05.002. eCollection 2019 Jul.
Implantable cardioverter defibrillator (ICD) therapy is lifesaving; however, real-world data regarding the proportion of patients eligible for a primary prevention ICD and subsequent use remain sparse. This study evaluated rates of primary prevention ICD eligibility and use among patients in heart function clinics (HFCs) and to identify reasons for nonimplantation.
A retrospective study was performed of patients seen at HFCs in Alberta, Canada, from 2013 to 2015. Demographics, comorbidities, clinical indications, and reasons for nonimplantation were abstracted. Eligibility was defined according to the 2008 American College of Cardiology/American Heart Association/Heart Rhythm Society ICD, 2012 American College of Cardiology/American Heart Association/Heart Rhythm Society Focused Update, and 2013 Canadian Cardiovascular Society Cardiac Resynchronization Therapy guidelines. Logistic regression was used to calculate an odds ratio (OR) and 95% confidence interval (CI) for predictors of nonimplantation.
Among 1239 patients in HFCs, the median age was 70 years (interquartile range, 59-80), 67% were male, and the median left ventricular ejection fraction was 0.40 (interquartile range, 0.28-0.53). Overall, 45% of patients (n = 553) met guideline criteria for an ICD, and of those, 36% (n = 198) received a device. Among device nonrecipients, 52% (n = 185) had no documented reason for nonimplantation. The most common reason for nonimplantation among nonrecipients was patient preference (48%). Predictors associated with nonimplantation were age more than 75 years (OR, 1.92; 95% CI, 1.31-2.82) and history of cancer (OR, 2.26; 95% CI, 1.07-4.78). At 3 years follow-up, 27% of nonrecipients were deceased.
We found that one-third of patients who met guideline criteria received an ICD and that documentation for nonimplantation was poor.
植入式心脏复律除颤器（ICD）治疗可挽救生命；然而，关于符合一级预防ICD标准的患者比例及后续使用情况的真实世界数据仍然匮乏。本研究评估了心脏功能诊所（HFC）患者中一级预防ICD的符合率及使用率，并确定未植入的原因。
对2013年至2015年在加拿大艾伯塔省HFC就诊的患者进行回顾性研究。提取人口统计学、合并症、临床指征及未植入原因等信息。根据2008年美国心脏病学会/美国心脏协会/心律学会ICD指南、2012年美国心脏病学会/美国心脏协会/心律学会重点更新版以及2013年加拿大心血管学会心脏再同步治疗指南来定义符合标准情况。采用逻辑回归计算未植入预测因素的比值比（OR）及95%置信区间（CI）。
在HFC的1239例患者中，中位年龄为70岁（四分位间距，59 - 80岁），67%为男性，左心室射血分数中位数为0.40（四分位间距，0.28 - 0.53）。总体而言，45%的患者（n = 553）符合ICD指南标准，其中36%（n = 198）接受了该装置。在未接受装置的患者中，52%（n = 185）没有记录未植入的原因。未接受装置患者中最常见的未植入原因是患者偏好（48%）。与未植入相关的预测因素为年龄大于75岁（OR，1.92；95% CI，1.31 - 2.82）及癌症病史（OR，2.26；95% CI，1.07 - 4.78）。在3年随访时，27%的未接受装置患者已死亡。
我们发现，符合指南标准患者中有三分之一接受了ICD，且未植入的记录情况较差。
