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可穿戴式除颤器提高植入式除颤器候选者选择的准确性:一项真实世界经验。

Wearable defibrillator to improve accuracy in selecting candidates to implantable defibrillator: A real-world experience.

作者信息

Dell'Era Gabriele, Caimmi Philippe, Spinoni Enrico Guido, Battistini Eleonora, Porcellini Stefano, De Vecchi Federica, Santagostino Matteo, Ghiglieno Chiara, Degiovanni Anna, Leigheb Fabrizio, Kozel Daniela, Capponi Andrea, Patti Giuseppe

机构信息

Cardiology Unit, Maggiore della Carità Hospital of Novara, Novara, Italy.

Maggiore della Carità Hospital of Novara, Novara, Italy.

出版信息

ESC Heart Fail. 2024 Dec;11(6):3993-3999. doi: 10.1002/ehf2.14840. Epub 2024 Aug 1.

Abstract

AIMS

The indication for implantable cardioverter defibrillator (ICD) for sudden cardiac death (SCD) prevention relies mostly on left ventricular ejection fraction (LVEF) ≤ 35%. The use of a wearable cardioverter defibrillator (WCD) in the case of dynamic alterations of LVEF may help avoid an improper early ICD implant when a favourable evolution in the post-acute phase is observed and may help reduce costs.

METHODS

This parallel cohort retrospective study included patients with heart failure with reduced ejection fraction (HFrEF) at high risk of arrhythmias recruited in the acute phase and divided into an early ICD cohort and a WCD cohort for primary prevention during the waiting period established by European Society of Cardiology guidelines.

RESULTS

A total of 41 consecutive patients were enrolled: 26 in the WCD group and 15 in the early ICD group. Age, LVEF at baseline, causes of HFrEF and drug therapy in the two cohorts were similar. During the waiting period after the inclusion, three patients (11.5%) in the WCD cohort and four (26.7%) in the early ICD cohort developed relevant ventricular arrhythmias (P = 0.22); none of them had subsequent LVEF recovery. At the end of the waiting period, 13 patients (50%) in the WCD group and 7 (46.7%) in the early ICD group experienced LVEF recovery (P = 0.84). The average cost per patient at the end of the waiting period was €23 934 in the early ICD cohort versus €19 167 in the WCD cohort (-19.9%). This cost savings from WCD use appears even higher when projected over a 10 year period (-41.2%).

CONCLUSIONS

WCD may represent a cost-effective strategy to more accurately select candidates for the primary prevention ICD implant among high-risk patients with HFrEF. ICD use provides effective protection from SCD and reduces costs compared with an extensive early ICD implant.

摘要

目的

植入式心脏复律除颤器(ICD)预防心脏性猝死(SCD)的指征主要依赖于左心室射血分数(LVEF)≤35%。在LVEF动态变化的情况下,使用可穿戴式心脏复律除颤器(WCD)可能有助于避免在急性期后观察到病情向好演变时过早不恰当地植入ICD,并可能有助于降低成本。

方法

这项平行队列回顾性研究纳入了急性期招募的射血分数降低的心力衰竭(HFrEF)且心律失常风险高的患者,根据欧洲心脏病学会指南确定的等待期内,将其分为早期ICD队列和WCD队列进行一级预防。

结果

共连续纳入41例患者:WCD组26例,早期ICD组15例。两组患者的年龄、基线LVEF、HFrEF病因及药物治疗情况相似。纳入后的等待期内,WCD队列中有3例患者(11.5%)、早期ICD队列中有4例患者(26.7%)发生了相关室性心律失常(P = 0.22);他们均未出现随后的LVEF恢复。等待期结束时,WCD组有13例患者(50%)、早期ICD组有7例患者(46.7%)出现LVEF恢复(P = 0.84)。等待期结束时,早期ICD队列中每位患者的平均成本为23934欧元,而WCD队列中为19167欧元(降低了19.9%)。当按10年计算时,使用WCD节省的成本似乎更高(降低了41.2%)。

结论

WCD可能是一种具有成本效益的策略,可在HFrEF高危患者中更准确地筛选出一级预防ICD植入的候选人。与广泛早期植入ICD相比,使用ICD可有效预防SCD并降低成本。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fd65/11631226/ed44b54da914/EHF2-11-3993-g001.jpg

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