Primary prevention of sudden cardiac death

Preventing sudden cardiac death in post myocardial infarction patients with left ventricular dysfunction

Cardiovascular nurses play a key role in caring for the post myocardial infarction (MI) patient. That role includes reducing the risk of MI recurrence and the progression to heart failure. Equally important is evaluating for the risk of sudden cardiac death (SCD). Although drugs such as beta blockers and angiotensin converting enzyme (ACE) inhibitors are typically indicated to help reduce the risk of SCD, data continue to show that using implantable cardioverter defibrillators (ICDs) saves lives compared with using medications alone. This article focuses on the problem of SCD, the findings of recent clinical trials, the implant criteria for defibrillators, new Centers for Medicare & Medicaid Services (CMS) decisions regarding reimbursement, and postoperative care for the defibrillator patient. Included are 2 case studies demonstrating the nurses' role in identifying asymptomatic patients who are indicated for ICD therapy. It is critical that cardiovascular nurses be aware of the latest scientific evidence showing improved outcomes for post-MI patients, particularly those with left ventricular dysfunction.