Department of Internal Medicine, Aga Khan University, Nairobi, Kenya.
Brain and Mind Institute, Aga Khan University, Nairobi, Kenya.
Glob Heart. 2024 Aug 16;19(1):66. doi: 10.5334/gh.1346. eCollection 2024.
Efficacy of Implantable Cardioverter-Defibrillator (ICD) implantation in both primary and secondary prevention of Sudden Cardiac Death (SCD) in at-risk population is well established. ICD implantation rates remain low particularly in Africa with a paucity of data regarding factors associated with non-uptake.
The primary study objective was to determine the factors associated with non-uptake of ICD among heart failure (HF) patients with reduced ejection fraction (EF<35%). Reasons for ICD refusal among eligible patients were reviewed as a secondary objective.
This was a retrospective study among HF patients eligible for ICD implantation evaluated between 2018 to 2020. Comparison between ICD recipient and non-recipient categories was made to establish determinants of non-uptake.
Of 206 eligible patients, only 69 (33.5%) had an ICD. Factors independently associated with non-uptake were lack of private insurance (42.3% vs 63.8%; p = 0.005), non-cardiology physician (16.1% vs 5.8%; p = 0.045) and non-ischemic cardiomyopathy (54.7% vs 36.4% p = 0.014). The most common (75%) reason for ICD refusal was inability to pay for the device.
ICDs are underutilized among eligible HF with reduced EF patients in Kenya. The majority of patients without ICD had no private insurance, had non-ischemic cardiomyopathy and non-cardiology primary physician. Early referral of HF with reduced EF patients to HF specialists to optimize guideline-directed medical therapy and make ICD recommendation is needed.
植入式心脏复律除颤器（ICD）在高危人群中的一级和二级预防心源性猝死（SCD）中的疗效已得到充分证实。ICD 的植入率仍然很低，尤其是在非洲，关于与未接受 ICD 治疗相关的因素的数据很少。
本研究的主要目的是确定射血分数降低（EF<35%）心力衰竭（HF）患者中与 ICD 不接受相关的因素。作为次要目的，回顾了符合条件的患者拒绝 ICD 的原因。
这是一项对 2018 年至 2020 年间符合 ICD 植入条件的 HF 患者进行的回顾性研究。对 ICD 接受者和非接受者类别进行比较，以确定不接受 ICD 的决定因素。
在 206 名符合条件的患者中，仅有 69 名（33.5%）接受了 ICD。与 ICD 不接受相关的独立因素包括缺乏私人保险（42.3% vs 63.8%；p=0.005）、非心脏病学医师（16.1% vs 5.8%；p=0.045）和非缺血性心肌病（54.7% vs 36.4%；p=0.014）。拒绝植入 ICD 的最常见（75%）原因是无力支付设备费用。
在肯尼亚，射血分数降低的 HF 患者中 ICD 的使用率较低。没有 ICD 的大多数患者没有私人保险，患有非缺血性心肌病和非心脏病学的初级医师。需要将射血分数降低的 HF 患者尽早转介给 HF 专家，以优化指南导向的药物治疗并提出 ICD 建议。
