Implantable Cardioverter Defibrillator Therapy for Primary Prevention of Sudden Cardiac Death after Myocardial Infarction

Implications of International Guidelines

Paul W. X. Foley, Carol Addison, Stephanie B. Whinney, Kiran Patel, David Cunningham, Michael Frenneaux, Francisco Leyva

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Study Objective: To estimate the proportion of patients eligible for implantable cardioverter defibrillator (ICD) therapy for the primary prevention of sudden cardiac death after a myocardial infarction (MI), according to the current guidelines.

Methods: Eligibility was assessed retrospectively at 6 weeks in 513 post-MI survivors (age 66 +/- 13 years, left ventricular ejection fraction 48.2 +/- 17%) on the basis of an electrocardiogram and an echocardiogram.

Results: LVEF was <= 40% in 37% and <= 35% in 30%, and QRS duration was <120 ms in 89% and >= 120 ins in 11% of patients. The proportion of post-MI patients meeting the criteria set by guidelines were 37% for 2006 American College of Cardiology/American Heart Associotion/European Society of Cardiology (ACC/AHA/ESC) 26.5% for 2008 ACC/AHA/Canadian Heart Rhythm Society 16.3% for 2005 US Centers for Medicare and Medicaid Services (CMS), and 5.8% for the 2006 United Kingdom (UK) National Institute of Clinical Excellence (NICE). According to 2005 CMS and 2006 UK-NICE guidelines, Holter monitoring was required in 7% and 18%, respectively. For the United States (700,000 MI in 2006), the 2006 ACC/AHA/ESC guidelines equate to 216,783 ICD implantationslyear. For UK (60,499 MI in 2006), the 2006 NICE guidelines equate to 2,941 ICD implantations, 10,488 Holter studies, and 1,065 VT induction tests/year.

Conclusions: Current ICD therapy guidelines for primary prevention of SCD post-MI demand a substantial increase in service provision worldwide. (PACE 2009; 32:S131-S134)

Original languageEnglish
Pages (from-to)S131-134
Number of pages4
JournalPACE
Volume32
Issue numberSuppl. 1
DOIs
Publication statusPublished - Mar 2009

Keywords

  • primary prevention
  • sudden cardiac death
  • implantable cardioverter defibrillator
  • myocardial infarction
  • ventricular tachyarrhythmia
  • MADIT-II

Cite this

Implantable Cardioverter Defibrillator Therapy for Primary Prevention of Sudden Cardiac Death after Myocardial Infarction : Implications of International Guidelines. / Foley, Paul W. X.; Addison, Carol; Whinney, Stephanie B.; Patel, Kiran; Cunningham, David; Frenneaux, Michael; Leyva, Francisco.

In: PACE, Vol. 32, No. Suppl. 1, 03.2009, p. S131-134.

Research output: Contribution to journalArticle

Foley, Paul W. X. ; Addison, Carol ; Whinney, Stephanie B. ; Patel, Kiran ; Cunningham, David ; Frenneaux, Michael ; Leyva, Francisco. / Implantable Cardioverter Defibrillator Therapy for Primary Prevention of Sudden Cardiac Death after Myocardial Infarction : Implications of International Guidelines. In: PACE. 2009 ; Vol. 32, No. Suppl. 1. pp. S131-134.
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abstract = "Study Objective: To estimate the proportion of patients eligible for implantable cardioverter defibrillator (ICD) therapy for the primary prevention of sudden cardiac death after a myocardial infarction (MI), according to the current guidelines.Methods: Eligibility was assessed retrospectively at 6 weeks in 513 post-MI survivors (age 66 +/- 13 years, left ventricular ejection fraction 48.2 +/- 17{\%}) on the basis of an electrocardiogram and an echocardiogram.Results: LVEF was <= 40{\%} in 37{\%} and <= 35{\%} in 30{\%}, and QRS duration was <120 ms in 89{\%} and >= 120 ins in 11{\%} of patients. The proportion of post-MI patients meeting the criteria set by guidelines were 37{\%} for 2006 American College of Cardiology/American Heart Associotion/European Society of Cardiology (ACC/AHA/ESC) 26.5{\%} for 2008 ACC/AHA/Canadian Heart Rhythm Society 16.3{\%} for 2005 US Centers for Medicare and Medicaid Services (CMS), and 5.8{\%} for the 2006 United Kingdom (UK) National Institute of Clinical Excellence (NICE). According to 2005 CMS and 2006 UK-NICE guidelines, Holter monitoring was required in 7{\%} and 18{\%}, respectively. For the United States (700,000 MI in 2006), the 2006 ACC/AHA/ESC guidelines equate to 216,783 ICD implantationslyear. For UK (60,499 MI in 2006), the 2006 NICE guidelines equate to 2,941 ICD implantations, 10,488 Holter studies, and 1,065 VT induction tests/year.Conclusions: Current ICD therapy guidelines for primary prevention of SCD post-MI demand a substantial increase in service provision worldwide. (PACE 2009; 32:S131-S134)",
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KW - implantable cardioverter defibrillator

KW - myocardial infarction

KW - ventricular tachyarrhythmia

KW - MADIT-II

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SN - 0147-8389

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