Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review
<p class="first" id="d17685867e265"> <b>Background:</b> Implantable cardioverter-defibrillators (ICDs) can be life-saving devices, although they are expensive and may cause complications. In 2013, several professional societi...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Compuscript Ltd
2021-04-01
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| Series: | Cardiovascular Innovations and Applications |
| Online Access: | https://www.scienceopen.com/hosted-document?doi=10.15212/CVIA.2021.0005 |
| _version_ | 1797793512265089024 |
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| author | Nikhil H. Shah Steven J. Ross Steve A. Noutong Njapo Justin Merritt Andrew Kolarich Michael Kaufmann William M. Miles David E. Winchester Thomas A. Burkart Matthew McKillop |
| author_facet | Nikhil H. Shah Steven J. Ross Steve A. Noutong Njapo Justin Merritt Andrew Kolarich Michael Kaufmann William M. Miles David E. Winchester Thomas A. Burkart Matthew McKillop |
| author_sort | Nikhil H. Shah |
| collection | DOAJ |
| description | <p class="first" id="d17685867e265">
<b>Background:</b> Implantable cardioverter-defibrillators (ICDs) can be life-saving devices, although
they are expensive and may cause complications. In 2013, several professional societies
published joint appropriate use criteria (AUC) assessing indications for ICD implantation.
Data evaluating the clinical application of AUC are limited. Previous registry-based
studies estimated that 22.5% of primary prevention ICD implantations were “non-evidence-based”
implantations. On the basis of AUC, we aimed to determine the prevalence of “rarely
appropriate” ICD implantation at our institution for comparison with previous estimates.
</p><p id="d17685867e270">
<b>Methods:</b> We reviewed 286 patients who underwent ICD implantation between 2013 and 2016. Appropriateness
of each ICD implantation was assessed by independent review and rated on the basis
of AUC.
</p><p id="d17685867e275">
<b>Results:</b> Of 286 ICD implantations, two independent reviewers found that 89.5% and 89.2%, respectively,
were appropriate, 5.6% and 7.3% may be appropriate, and 1.8% and 2.1% were rarely
appropriate. No AUC indication was found for 3.5% and 3.4% of ICD implantations, respectively.
Secondary prevention ICD implantations were more likely rarely appropriate (2.6% vs.
1.2% and 3.6% vs. 1.1%) or unrated (6.0% vs. 1.2% and 2.7% vs. 0.6%). The reviewers
found 3.5% and 3.4% of ICD implantations, respectively, were non-evidence-based implantations.
The difference in rates between reviewers was not statistically significant.
</p><p id="d17685867e280">
<b>Conclusion:</b> Compared with prior reports, our prevalence of rarely appropriate ICD implantation
was very low. The high appropriate use rate could be explained by the fact that AUC
are based on current clinical practice. The AUC could benefit from additional secondary
prevention indications. Most importantly, clinical judgement and individualized care
should determine which patients receive ICDs irrespective of guidelines or criteria.
</p> |
| first_indexed | 2024-03-13T02:48:22Z |
| format | Article |
| id | doaj.art-4a6c4d0383e3449482dfdc8597ff55eb |
| institution | Directory Open Access Journal |
| issn | 2009-8618 2009-8782 |
| language | English |
| last_indexed | 2024-03-13T02:48:22Z |
| publishDate | 2021-04-01 |
| publisher | Compuscript Ltd |
| record_format | Article |
| series | Cardiovascular Innovations and Applications |
| spelling | doaj.art-4a6c4d0383e3449482dfdc8597ff55eb2023-06-28T14:11:22ZengCompuscript LtdCardiovascular Innovations and Applications2009-86182009-87822021-04-015423510.15212/CVIA.2021.0005Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective ReviewNikhil H. ShahSteven J. RossSteve A. Noutong NjapoJustin MerrittAndrew KolarichMichael KaufmannWilliam M. MilesDavid E. WinchesterThomas A. BurkartMatthew McKillop<p class="first" id="d17685867e265"> <b>Background:</b> Implantable cardioverter-defibrillators (ICDs) can be life-saving devices, although they are expensive and may cause complications. In 2013, several professional societies published joint appropriate use criteria (AUC) assessing indications for ICD implantation. Data evaluating the clinical application of AUC are limited. Previous registry-based studies estimated that 22.5% of primary prevention ICD implantations were “non-evidence-based” implantations. On the basis of AUC, we aimed to determine the prevalence of “rarely appropriate” ICD implantation at our institution for comparison with previous estimates. </p><p id="d17685867e270"> <b>Methods:</b> We reviewed 286 patients who underwent ICD implantation between 2013 and 2016. Appropriateness of each ICD implantation was assessed by independent review and rated on the basis of AUC. </p><p id="d17685867e275"> <b>Results:</b> Of 286 ICD implantations, two independent reviewers found that 89.5% and 89.2%, respectively, were appropriate, 5.6% and 7.3% may be appropriate, and 1.8% and 2.1% were rarely appropriate. No AUC indication was found for 3.5% and 3.4% of ICD implantations, respectively. Secondary prevention ICD implantations were more likely rarely appropriate (2.6% vs. 1.2% and 3.6% vs. 1.1%) or unrated (6.0% vs. 1.2% and 2.7% vs. 0.6%). The reviewers found 3.5% and 3.4% of ICD implantations, respectively, were non-evidence-based implantations. The difference in rates between reviewers was not statistically significant. </p><p id="d17685867e280"> <b>Conclusion:</b> Compared with prior reports, our prevalence of rarely appropriate ICD implantation was very low. The high appropriate use rate could be explained by the fact that AUC are based on current clinical practice. The AUC could benefit from additional secondary prevention indications. Most importantly, clinical judgement and individualized care should determine which patients receive ICDs irrespective of guidelines or criteria. </p>https://www.scienceopen.com/hosted-document?doi=10.15212/CVIA.2021.0005 |
| spellingShingle | Nikhil H. Shah Steven J. Ross Steve A. Noutong Njapo Justin Merritt Andrew Kolarich Michael Kaufmann William M. Miles David E. Winchester Thomas A. Burkart Matthew McKillop Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review Cardiovascular Innovations and Applications |
| title | Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review |
| title_full | Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review |
| title_fullStr | Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review |
| title_full_unstemmed | Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review |
| title_short | Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review |
| title_sort | better than you think appropriate use of implantable cardioverter defibrillators at a single academic center a retrospective review |
| url | https://www.scienceopen.com/hosted-document?doi=10.15212/CVIA.2021.0005 |
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