Abstract 17618: Use of Implantable Cardioverter Defibrillators in Specialized Multidisciplinary Outpatient Clinics: Insights from the Canadian Heart Failure Network
Background: Implantable cardioverter defibrillators (ICD) are indicated for primary prophylaxis of sudden cardiac death in patients with mild to moderate heart failure (HF) due to left ventricular systolic dysfunction (LVEF < 35%). The Canadian Heart Failure Network (CHFN) of multidisciplinary HF outpatient clinics (n=26) have enrolled and followed HF patients in both academic and community centers from 1999 to 2010. We sought to determine ICD usage rates for qualifying patients treated in specialty HF clinics in Canada.
Methods: A common electronic database was used to collect patient data and conduct analyses of patient management and outcomes. We describe the usage of ICDs in eligible patients with chronic HF who were followed > 1 year, and who had documented LVEF <35% within 1 year of initial clinic visit.
Results: Of 12,095 identified cases, LVEF < 35% was documented in 7,954 (66%). The mean age was 69 years of age (+/- 14.3), 69% were male and 51% had documented ischemic etiology for HF. Baseline NYHA class distribution was I (13%), II (40%), III (43%) and IV (4%). There were 2,415 patients with an ICD implanted (31%), of which 1,703 (70%) were implanted prior to the first clinic visit. Following HF clinic enrolment, there was a further 712 new ICD implantations, nearly half of which (45%) occurred after the first year of HF clinic care. The LVEF was <30% in 77% of all patients with an ICD.
Conclusions: Follow up of HF outpatients in Canadian multidisciplinary HF clinics identifies a higher ICD implantation rate than previously reported. Following patient enrolment in a HF clinic, there is a significant and increase in ICD implantation. Further study is required to understand to understand the decisions leading to ICD implantation in the referred outpatient population.
- © 2012 by American Heart Association, Inc.