Prevalence and outcomes of patients receiving implantable cardioverter-defibrillators for primary prevention not based on guidelines

Yehoshua Levine, Mark K. Tuttle, Michael A. Rosenberg, Randal Goldberg, Jason Matos, Michelle Samuel, Daniel B. Kramer, Alfred E. Buxton

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Implantable cardioverter-defibrillator (ICD) implantation outside practice guidelines remains contentious, particularly during the mandated waiting periods in patients with recent cardiac events. We assessed the prevalence and outcomes of non-guideline-based (NGB) ICD implantations in a tertiary academic medical center, with a specific focus on adjudication of arrhythmia events. All patients who underwent initial primary prevention ICD implantation at our institution from 2004 to 2012 were categorized as having received guideline-based (GB) or NGB implants and were retrospectively assessed for first episode of appropriate ICD therapy and total mortality. Of 807 patients, 137 (17.0%) received NGB implants. During a median follow-up of 2.9 years, patients with NGB implants had similar times to first appropriate ICD therapy (median time to event 1.94 vs 2.17 years in patients with GB implants, p = 0.20). After multivariable analysis, patients with NGB implants remained at higher risk for death (hazard ratio 1.54, 95% confidence interval 1.1 to 2.2, p = 0.03) but not appropriate ICD therapy (hazard ratio 0.83, 95% confidence interval 0.5 to 1.3, p = 0.51). Furthermore, only 1 of 125 patients who underwent implant within the 40-day waiting period after myocardial infarction or 3-month waiting period after revascularization or cardiomyopathy diagnosis received an appropriate therapy within this period. In conclusion, few patients received NGB ICD implants in our academic medical center. Although these patients have similar long-term risk of receiving appropriate ICD therapy compared with patients with GB implants, this risk is very low during the waiting periods mandated by clinical practice guidelines. These results suggest that there is little need to rush into implanting ICDs during these waiting periods.

Original languageEnglish (US)
Pages (from-to)1539-1544
Number of pages6
JournalAmerican Journal of Cardiology
Volume115
Issue number11
DOIs
StatePublished - Jun 1 2015
Externally publishedYes

Fingerprint

Implantable Defibrillators
Primary Prevention
Guidelines
Practice Guidelines
Confidence Intervals
Therapeutics
Cardiomyopathies
Cardiac Arrhythmias
Myocardial Infarction
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Prevalence and outcomes of patients receiving implantable cardioverter-defibrillators for primary prevention not based on guidelines. / Levine, Yehoshua; Tuttle, Mark K.; Rosenberg, Michael A.; Goldberg, Randal; Matos, Jason; Samuel, Michelle; Kramer, Daniel B.; Buxton, Alfred E.

In: American Journal of Cardiology, Vol. 115, No. 11, 01.06.2015, p. 1539-1544.

Research output: Contribution to journalArticle

Levine, Yehoshua ; Tuttle, Mark K. ; Rosenberg, Michael A. ; Goldberg, Randal ; Matos, Jason ; Samuel, Michelle ; Kramer, Daniel B. ; Buxton, Alfred E. / Prevalence and outcomes of patients receiving implantable cardioverter-defibrillators for primary prevention not based on guidelines. In: American Journal of Cardiology. 2015 ; Vol. 115, No. 11. pp. 1539-1544.
@article{386906bd7dbe4f67bcb0c98f1dd5832d,
title = "Prevalence and outcomes of patients receiving implantable cardioverter-defibrillators for primary prevention not based on guidelines",
abstract = "Implantable cardioverter-defibrillator (ICD) implantation outside practice guidelines remains contentious, particularly during the mandated waiting periods in patients with recent cardiac events. We assessed the prevalence and outcomes of non-guideline-based (NGB) ICD implantations in a tertiary academic medical center, with a specific focus on adjudication of arrhythmia events. All patients who underwent initial primary prevention ICD implantation at our institution from 2004 to 2012 were categorized as having received guideline-based (GB) or NGB implants and were retrospectively assessed for first episode of appropriate ICD therapy and total mortality. Of 807 patients, 137 (17.0{\%}) received NGB implants. During a median follow-up of 2.9 years, patients with NGB implants had similar times to first appropriate ICD therapy (median time to event 1.94 vs 2.17 years in patients with GB implants, p = 0.20). After multivariable analysis, patients with NGB implants remained at higher risk for death (hazard ratio 1.54, 95{\%} confidence interval 1.1 to 2.2, p = 0.03) but not appropriate ICD therapy (hazard ratio 0.83, 95{\%} confidence interval 0.5 to 1.3, p = 0.51). Furthermore, only 1 of 125 patients who underwent implant within the 40-day waiting period after myocardial infarction or 3-month waiting period after revascularization or cardiomyopathy diagnosis received an appropriate therapy within this period. In conclusion, few patients received NGB ICD implants in our academic medical center. Although these patients have similar long-term risk of receiving appropriate ICD therapy compared with patients with GB implants, this risk is very low during the waiting periods mandated by clinical practice guidelines. These results suggest that there is little need to rush into implanting ICDs during these waiting periods.",
author = "Yehoshua Levine and Tuttle, {Mark K.} and Rosenberg, {Michael A.} and Randal Goldberg and Jason Matos and Michelle Samuel and Kramer, {Daniel B.} and Buxton, {Alfred E.}",
year = "2015",
month = "6",
day = "1",
doi = "10.1016/j.amjcard.2015.02.056",
language = "English (US)",
volume = "115",
pages = "1539--1544",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "11",

}

TY - JOUR

T1 - Prevalence and outcomes of patients receiving implantable cardioverter-defibrillators for primary prevention not based on guidelines

AU - Levine, Yehoshua

AU - Tuttle, Mark K.

AU - Rosenberg, Michael A.

AU - Goldberg, Randal

AU - Matos, Jason

AU - Samuel, Michelle

AU - Kramer, Daniel B.

AU - Buxton, Alfred E.

PY - 2015/6/1

Y1 - 2015/6/1

N2 - Implantable cardioverter-defibrillator (ICD) implantation outside practice guidelines remains contentious, particularly during the mandated waiting periods in patients with recent cardiac events. We assessed the prevalence and outcomes of non-guideline-based (NGB) ICD implantations in a tertiary academic medical center, with a specific focus on adjudication of arrhythmia events. All patients who underwent initial primary prevention ICD implantation at our institution from 2004 to 2012 were categorized as having received guideline-based (GB) or NGB implants and were retrospectively assessed for first episode of appropriate ICD therapy and total mortality. Of 807 patients, 137 (17.0%) received NGB implants. During a median follow-up of 2.9 years, patients with NGB implants had similar times to first appropriate ICD therapy (median time to event 1.94 vs 2.17 years in patients with GB implants, p = 0.20). After multivariable analysis, patients with NGB implants remained at higher risk for death (hazard ratio 1.54, 95% confidence interval 1.1 to 2.2, p = 0.03) but not appropriate ICD therapy (hazard ratio 0.83, 95% confidence interval 0.5 to 1.3, p = 0.51). Furthermore, only 1 of 125 patients who underwent implant within the 40-day waiting period after myocardial infarction or 3-month waiting period after revascularization or cardiomyopathy diagnosis received an appropriate therapy within this period. In conclusion, few patients received NGB ICD implants in our academic medical center. Although these patients have similar long-term risk of receiving appropriate ICD therapy compared with patients with GB implants, this risk is very low during the waiting periods mandated by clinical practice guidelines. These results suggest that there is little need to rush into implanting ICDs during these waiting periods.

AB - Implantable cardioverter-defibrillator (ICD) implantation outside practice guidelines remains contentious, particularly during the mandated waiting periods in patients with recent cardiac events. We assessed the prevalence and outcomes of non-guideline-based (NGB) ICD implantations in a tertiary academic medical center, with a specific focus on adjudication of arrhythmia events. All patients who underwent initial primary prevention ICD implantation at our institution from 2004 to 2012 were categorized as having received guideline-based (GB) or NGB implants and were retrospectively assessed for first episode of appropriate ICD therapy and total mortality. Of 807 patients, 137 (17.0%) received NGB implants. During a median follow-up of 2.9 years, patients with NGB implants had similar times to first appropriate ICD therapy (median time to event 1.94 vs 2.17 years in patients with GB implants, p = 0.20). After multivariable analysis, patients with NGB implants remained at higher risk for death (hazard ratio 1.54, 95% confidence interval 1.1 to 2.2, p = 0.03) but not appropriate ICD therapy (hazard ratio 0.83, 95% confidence interval 0.5 to 1.3, p = 0.51). Furthermore, only 1 of 125 patients who underwent implant within the 40-day waiting period after myocardial infarction or 3-month waiting period after revascularization or cardiomyopathy diagnosis received an appropriate therapy within this period. In conclusion, few patients received NGB ICD implants in our academic medical center. Although these patients have similar long-term risk of receiving appropriate ICD therapy compared with patients with GB implants, this risk is very low during the waiting periods mandated by clinical practice guidelines. These results suggest that there is little need to rush into implanting ICDs during these waiting periods.

UR - http://www.scopus.com/inward/record.url?scp=84929282071&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84929282071&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2015.02.056

DO - 10.1016/j.amjcard.2015.02.056

M3 - Article

C2 - 25840578

AN - SCOPUS:84929282071

VL - 115

SP - 1539

EP - 1544

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 11

ER -