Abstract 12222: Use of a Reminder Statement on Echocardiography Reports Increases Appropriate Referral for Implantable Cardioverter-Defibrillators for Primary Prevention
Background: Numerous trials have shown the benefit of ICDs for primary prevention in patients with low EF and history of CHF, and guidelines recommend their use. Still, underutilization is well-documented.
Hypothesis: Placing a reminder statement into echocardiogram reports for appropriate patients will increase adherence to guidelines.
Methods: From January to June 2013, a brief statement reminding clinicians of the ICD guidelines was automatically inserted into the body of echocardiogram reports for patients with an EF ≤ 35% at a single center (intervention group). Charts were reviewed to determine if these patients were 1) referred to EP and 2) received an ICD, within six months. We reviewed medical records of all patients with the same criteria between March and August 2012 to establish a historical control group. Patients were considered inappropriate for EP referral if they had an ICD, repeat echo within 6 months of index echocardiogram with an EF>35%, expired within 6 months, end stage disease, dementia, refused an ICD in the past, had a DNR order, or had class IV heart failure with a QRS<120 ms. Patients were considered inappropriate for ICD placement if they had an active infection, developed a new contraindication after seeing EP, or were considered inappropriate by EP consult.
Results: There was a significant increase in appropriate EP referrals in the intervention group compared with the control, 76.1% versus 58.9% (p = 0.03). Among patients appropriate for ICD, 57.9% of patients in the intervention group received an ICD versus 44.2% of controls (p = 0.13). Referral of inappropriate patients to EP did not increase (see Table).
Conclusions: A simple reminder statement on echocardiography reports led to a significant increase in appropriate EP referrals and a trend towards increased ICD implantation in appropriate patients. This essentially free quality improvement intervention improves adherence to ICD guidelines.
Author Disclosures: M. Chokshi: None. R.L. McNamara: None. Y. Rajeswaran: None. R. Lampert: Research Grant; Significant; Medtronic, Boston Scientific, St Jude Medical, GE Medical.
- © 2014 by American Heart Association, Inc.