Yonsei Med J.  2020 Nov;61(11):942-950. 10.3349/ymj.2020.61.11.942.

Clinical and Hospital Factors Affecting Treatment with Primary Prevention Implantable CardioverterDefibrillators in Ischemic Cardiomyopathy Patients

Affiliations
  • 1Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
  • 2Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 3Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  • 4Division of Cardiology, Department of Internal Medicine, CHA Bundang University Hospital, Seongnam, Korea.
  • 5Division of Cardiology, Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Korea.
  • 6Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Seoul, Korea.
  • 7Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
  • 8Division of Cardiology, Department of Internal Medicine, Ewha Womans University Hospital, Seoul, Korea.

Abstract

Purpose
Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemic cardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM.
Materials and Methods
In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who were eligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital and clinical factors, were investigated.
Results
Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0–78.0) years], only 76 (5.2%) patients underwent ICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and total hospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospital system score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10–1.50] was an independent factor for predicting ICD implantation, along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97–17.87) and younger age (<70 years: OR, 2.14; 95% CI, 1.30–3.53).
Conclusion
PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICD implantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantation rate (Clinical trial registration No. NCT03590925).

Keyword

Defibrillators; implantable; myocardial ischemia; primary prevention
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