Abstract 657: Use of a Screening Tool Improves Appropriate Referral for Implantable Cardioverter Defibrillators for Primary Prevention
Background: The AHA/ACC released guidelines in 2006 recommending the use of ICDs in patients with EF less than 35%, congestive heart failure and/or myocardial infarction. Several studies have suggested that ICDs for primary prevention are underutilized. We sought to determine if use of a screening tool would increase adherence to guidelines.
Methods: Data were collected prospectively at the Yale Cardiology Group office during September and October 2007 (screening period). All patients’ charts were flagged with a screening tool that asked if the EF was less than 35%; if they were referred to an electrophysiologist (EP) and if not, why not. Clinical and demographic data were collected by chart review to determine appropriateness of referral. Control data were obtained through retrospective review of charts corresponding to all patient visits during March and April 2007 (control period).
Results: As shown in the table⇓, the screening tool increased appropriate referral, from 39% of appropriate patients in the control group, to 72% during the screening period (p=0.06). More patients had been evaluated by an EP prior to the visit in the screening period (71%) than in the control period (47%). Approximately 2/3 of patients offered referral declined in both time periods.
Conclusions: In this study, the first to investigate if a screening tool in the outpatient setting would increase the rate of appropriate patient referral for ICD as recommended by current ACC/AHA guidelines, utilization of a screening tool showed a trend toward increased physician adherence to guidelines. Surprisingly, over half of patients offered EP referral for ICD declined. Patient education regarding the benefits of ICDs may also increase appropriate use of this life-saving device.