Abstract P87: Implantable Cardioverter-Defibrillator Underutilization in Primay Prevention Patients
Introduction: While primary prevention implantable cardioverter-defibrillator (ICDs) have been shown to reduce mortality in high risk populations (EF≤35%), the percentage of eligible candidates receiving ICDs has not been well studied. Limited studies reveal that implants rate are low and range from 10 –33%. We sought to identify the clinical variables that were associated with ICD implants at our center.
Methods: Over a one year period (2005), 13,920 echos were performed at our center. Of those echos, 4814 (34%) had EF ≤ 35%. We randomly examined 5% of our echo data (200 echos) including demographic data to see what clinical variables influenced ICD implants at our center. Student T test and Chi-X testing was used for statistical analysis.
Results: 200 pts were identified with an EF≤35%, 96% of those patients were considered eligible for an ICD. 12% of pts EF improved, 12% of pts died acutely, 2% of pts refused, and 21% of pts had contraindications (advanced age >85, active malignancy) to implant. Of the remaining eligible pts, the implant rate was 68%. The ordering physician was the strongest predictor of which patients appropriately received an ICD. When the echo was ordered by a cardiologist, the implant rate was 74%. When the echo was ordered by a non cardiologist, the implant rate was 34%. This finding was significant with a P value of 0.0017.
Conclusions: Among eligible candidates at our center, the strongest predictor as to whether a patient received an ICD was determined by which physician ordered their echo. The ICD implant rate was significantly higher when the echo was ordered by a cardiologist vs. a non cardiologist. This study suggests that one of the reasons that ICD implant rates are so low in eligible patients is that non cardiologists may be unaware of their benefit in reducing mortality.