Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Yonsei Med J. 2020 Nov;61(11):942-950. doi: 10.3349/ymj.2020.61.11.942.
Implantable 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.
In 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.
Of 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%, =0.001) and total hospital system score (6.0 vs. 5.0, =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).
PP 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).
植入式心脏复律除颤器（ICD）是缺血性心肌病（ICM）患者一级预防（PP）的标准治疗方法。然而，在亚洲国家，PP ICD 的植入率较低。本研究旨在调查 ICD 植入率以及与 ICM 患者 PP ICD 植入相关的因素。
在这项前瞻性多中心观察性登记研究（ADVANCE-ICM 登记研究）中，筛选并纳入了适合 PP ICD 的 ICM 患者。研究了与适当 ICD 植入相关的因素，包括医院和临床因素。
在符合 PP ICD 条件的 1453 例 ICM 患者中[1111 例男性；中位年龄 71.0（61.0-78.0）岁]，仅有 76 例（5.2%）患者接受了 ICD 植入。在医院因素方面，与非经济激励转诊（72.4%比 52.9%，=0.001）和总医院系统评分（6.0 比 5.0，=0.013）较高的患者相比，ICD 组的 ICD 植入率更高。多变量分析显示，总医院系统评分[比值比（OR），1.28；95%置信区间（CI），1.10-1.50]是预测 ICD 植入的独立因素，同时还包括临床因素，包括较高的纽约心脏协会（NYHA）分级（≥III 级：OR，7.29；95%CI，2.97-17.87）和较年轻的年龄（<70 岁：OR，2.14；95%CI，1.30-3.53）。
韩国对 ICM 患者进行 PP ICD 植入的使用率较低。医院因素对于提高 PP ICD 植入率很重要，这表明为 ICM 患者建立新的筛查和转诊系统将提高 PP ICD 植入率（临床试验注册号：NCT03590925）。
