Factors influencing the use of implantable cardioverter-defibrillators for primary prevention in ischemic cardiomyopathy according to implantation volume: a prospective multicenter registry
- Author:
Tae-Hoon KIM
1
;
Hee Tae YU
;
Il-Young OH
;
Eue-Keun CHOI
;
Jung-Hoon SUNG
;
Young Soo LEE
;
Jong-Youn KIM
;
Yong-Soo BAEK
;
Junbeom PARK
;
Boyoung JOUNG
;
Author Information
- Publication Type:Research
- From:International Journal of Arrhythmia 2026;27(1):e8-
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background and Objectives:Primary prevention (PP) implantable cardioverter-defibrillator (ICD) therapy for ischemic cardiomyopathy (ICM) is underused in Asian countries, including South Korea. Both clinical and hospital factors may influence appropriate ICD use. We evaluated whether determinants of PP ICD implantation differ by hospital implantation volume.
Methods:In this prospective, multicenter observational registry (blinded for review), patients eligible for PP ICD were enrolled. Factors associated with ICD implantation—clinical characteristics and hospital-level systems—were examined across 4 large-volume hospitals (≥ 15 implants during the study) and 12 small-volume hospitals (< 15). Multivariable logistic regression identified independent predictors.
Results:Among 3,083 ICM patients (2,403 men; median age 70 years), PP ICD implantation rates were 10.8% in large-volume and 5.7% in small-volume hospitals. Across groups, male sex and chronic kidney disease independently predicted ICD implantation. Regarding hospital factors, non-monetary incentives for referral were the sole independent predictor in large-volume centers (odds ratio [OR], 3.55; 95% confidence interval [CI], 2.07–6.10;P < 0.001). In small-volume centers, heart failure conferences (OR, 12.73; 95% CI, 1.72–94.37;P = 0.013), structured education systems (OR, 11.72; 95% CI, 2.45–56.12; P = 0.02), and pacemaker clinics (OR, 11.4; 95% CI, 2.24–58.39; P = 0.003) were independently associated with implantation.
Conclusions:Clinical predictors of PP ICD use were consistent across hospital volumes, but hospital-level determinants differed. Referral incentives characterized large-volume centers, whereas conferences, education systems, and pacemaker clinics were key in smallvolume centers. Tailored institutional strategies by hospital volume may help close the PP ICD underuse gap and improve evidence-based implementation.
