Clinical and Hospital Factors Affecting Treatment with Primary Prevention Implantable CardioverterDefibrillators in Ischemic Cardiomyopathy Patients
10.3349/ymj.2020.61.11.942
- Author:
Jae-Hyuk LEE
1
;
Hee Tae YU
;
Il-Young OH
;
Eue-Keun CHOI
;
Jung-Hoon SUNG
;
Young Soo LEE
;
Jong-Youn KIM
;
Yongsoo BAEK
;
Junbeom PARK
;
Boyoung JOUNG
;
Author Information
1. Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Korea.
- Publication Type:Original Article
- From:Yonsei Medical Journal
2020;61(11):942-950
- CountryRepublic of Korea
- Language:English
-
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).
