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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AB - 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 - sudden cardiac death

KW - implantable cardioverter defibrillator

KW - myocardial infarction

KW - ventricular tachyarrhythmia

KW - MADIT-II

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SN - 0147-8389

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