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Ueda N, Noda T, Kusano K, Yasuda S, Kurita T, Shimizu W. Use of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death in Asia. JACC. ASIA 2023; 3:335-345. [PMID: 37323866 PMCID: PMC10261895 DOI: 10.1016/j.jacasi.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/13/2023] [Indexed: 06/17/2023]
Abstract
The effectiveness of primary prevention implantable cardioverter-defibrillators (ICDs) is well established. However, there are several unsolved problems related to ICD use for primary prevention in Asia, including ICD underuse, population differences in underlying heart disease, and the rate of appropriate ICD therapy compared with Western countries. Although the prevalence of ischemic cardiomyopathy in Asia is lower than in Europe and the United States, the mortality rate of Asian patients with ischemic heart disease has been increasing recently. As for the use of ICDs for primary prevention, there have been no randomized clinical trials, and limited data are available in Asia. This review focuses on the unmet needs related to ICD use for primary prevention in Asia.
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Affiliation(s)
- Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kurita
- Department of Internal Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Enard KR, Coleman AM, Yakubu RA, Butcher BC, Tao D, Hauptman PJ. Influence of Social Determinants of Health on Heart Failure Outcomes: A Systematic Review. J Am Heart Assoc 2023; 12:e026590. [PMID: 36695317 PMCID: PMC9973629 DOI: 10.1161/jaha.122.026590] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Prior research suggests an association between clinical outcomes in heart failure (HF) and social determinants of health (SDoH). Because providers should identify and address SDoH in care delivery, we evaluated how SDoH have been defined, measured, and evaluated in studies that examine HF outcomes. Methods and Results Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, databases were searched for observational or interventional studies published between 2009 and 2021 that assessed the influence of SDoH on outcomes. Selected articles were assessed for quality using a validated rating scheme. We identified 1373 unique articles for screening; 104 were selected for full-text review, and 59 met the inclusion criteria, including retrospective and prospective cohort, cross-sectional, and intervention studies. The majority examined readmissions and hospitalizations (k=33), mortality or survival (k=29), and success of medical devices and transplantation (k=8). SDoH examined most commonly included race, ethnicity, age, sex, socioeconomic status, and education or health literacy. Studies used a range of 1 to 9 SDoH as primary independent variables and 0 to 7 SDoH as controls. Multiple data sources were employed and frequently were electronic medical records linked with national surveys and disease registries. The effects of SDoH on HF outcomes were inconsistent because of the heterogeneity of data sources and SDoH constructs. Conclusions Our systematic review reveals shortcomings in measurement and deployment of SDoH variables in HF care. Validated measures need to be prospectively and intentionally collected to facilitate appropriate analysis, reporting, and replication of data across studies and inform the design of appropriate, evidence-based interventions that can ameliorate significant HF morbidity and societal costs.
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Affiliation(s)
- Kimberly R. Enard
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - Alyssa M. Coleman
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | - R. Aver Yakubu
- College for Public Health and Social JusticeSaint Louis UniversitySaint LouisMO
| | | | - Donghua Tao
- Medical Center LibrarySaint Louis UniversitySaint LouisMO
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Zhang S, Chen WJ, Sankardas MA, Ahmed WH, Liew HB, Gwon HC, Nesa Malik FT, Tang B, Haggui A, Oh IY, Ong TK, Cheng CI, Liu X, Seth A, Choi YJ, Qamar N, Rungpradubvong V, Wang CC, Jeon J, Wong G, Lemme F, Van Dorn B, Lexcen D, Huang D. Improve the Prevention of Sudden Cardiac Arrest in Patients With Post-Acute Myocardial Infarction. JACC. ASIA 2022; 2:559-571. [PMID: 36518723 PMCID: PMC9743445 DOI: 10.1016/j.jacasi.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients varies by geography but remains low in many regions despite guideline recommendations. OBJECTIVES This study aimed to characterize the care pathway of post-MI patients and understand barriers to referral for further SCD risk stratification and management in patients meeting referral criteria. METHODS This prospective, nonrandomized, multi-nation study included patients ≥18 years of age, with an acute MI ≤30 days and left ventricular ejection fraction <50% ≤14 days post-MI. The primary endpoint was defined as the physician's decision to refer a patient for SCD stratification and management. RESULTS In total, 1,491 post-MI patients were enrolled (60.2 ± 12.0 years of age, 82.4% male). During the study, 26.7% (n = 398) of patients met criteria for further SCD risk stratification; however, only 59.3% of those meeting criteria (n = 236; 95% CI: 54.4%-64.0%) were referred for a visit. Of patients referred for SCD risk stratification and management, 94.9% (n = 224) attended the visit of which 56.7% (n =127; 95% CI: 50.1%-63.0%) met ICD indication criteria. Of patients who met ICD indication criteria, 14.2% (n = 18) were implanted. CONCLUSIONS We found that ∼40% of patients meeting criteria were not referred for further SCD risk stratification and management and ∼85% of patients who met ICD indications did not receive a guideline-directed ICD. Physician and patient reasons for refusing referral to SCD risk stratification and management or ICD implant varied by geography suggesting that improvement will require both physician- and patient-focused approaches. (Improve Sudden Cardiac Arrest [SCA] Bridge Study; NCT03715790).
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Key Words
- CRT-D, cardiac resynchronization therapy-defibrillator
- ICD, implantable cardioverter-defibrillator
- ISC, India subcontinent
- LVEF, left ventricular ejection fraction
- MEACAT, Middle East, Africa, Central Asia, and Turkey
- MI, myocardial infarction
- OR, odds ratio
- SCD, sudden cardiac death
- SEA, South East Asia
- cardiac resynchronization therapy–defibrillator
- delivery of health care
- implantable cardioverter-defibrillator
- myocardial infarction
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Affiliation(s)
- Shu Zhang
- Fu Wai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | | | - Houng-Bang Liew
- Clinical Research Centre, Queen Elizabeth Hospital II, Sabah, Malaysia
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Baopeng Tang
- Fu Wai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | | | - Il-Young Oh
- National Taiwan University Hospital, Taipei, Taiwan
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Cheng-I Cheng
- Kaohsiung Chang Gung Memorial Hospital of CGMF, Kaohsiung, Taiwan
| | - Xingbin Liu
- West China Hospital, Sichuan University, Chengdu, China
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | | | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Voravut Rungpradubvong
- Fortis Escorts Heart Institute, New Delhi, India
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chun-Chieh Wang
- Chang Gung Memorial Hospital Linkou and Chang Gung University, Taoyuan City, Taiwan
| | | | - Grace Wong
- Medtronic Australasia, Sydney, Australia
| | - Francesca Lemme
- National Taiwan University Hospital, Taipei, Taiwan
- Medtronic Bakken Research Center, Maastricht, the Netherlands
| | | | - Dan Lexcen
- National Taiwan University Hospital, Taipei, Taiwan
| | - Dejia Huang
- National Taiwan University Hospital, Taipei, Taiwan
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Ahmed I, Merchant FM, Curtis JP, Parzynski CS, Lampert R. Impact of insurance status on ICD implantation practice patterns: Insights from the NCDR ICD registry. Am Heart J 2021; 235:44-53. [PMID: 33503408 DOI: 10.1016/j.ahj.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Whether insurance status influences practice patterns in implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) defibrillators, when indicated, is not known. METHODS AND RESULTS We analyzed the NCDR ICD Registry to evaluate associations of insurance status with guidelines-based receipt of CRT, as well as device-type, complication rates, and use of optimal medical therapy defined by guidelines. Among 798,028 patients with de novo ICD implants, we included only patients < 65 years (those older have Medicare) and excluded those admitted before 2006 (n=1,835) or with insurance coverage other than Medicare, Medicaid or private insurance (n=25,695) leaving 286,556 for analysis. Inverse probability of treatment weighting was used to control for imbalances between groups. Mean age was 53 years, 29% were female. Patients with private insurance and Medicare were more likely to receive CRT-D when indicated (79.6%, OR 1.19 95% CI 1.09-1.28, P <.001 and 78.5%, OR 1.11 95% CI 1.01-1.21 P = .03, respectively) compared to the uninsured (76.7%). The uninsured were also more likely than other groups to receive a single-chamber device. Complication rates did not differ. Uninsured patients were, however, more likely to receive optimal medical therapy, particularly in the subgroup receiving the implant for primary prevention. CONCLUSIONS In propensity-weighted analysis, uninsured patients are less likely to receive CRT when indicated but more likely to be receiving optimal medical therapy at discharge. Reasons for differences in device implantation practices based on insurance status require further study.
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Peinado Peinado R. La adherencia a una programación óptima del DAI: una asignatura pendiente. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Loughlin G, Datino T, Arenal Á, Ruiz-Granell R, Sánchez-Gómez JM, Pérez L, Martínez-Ferrer J, Alzueta J, Pérez-Lorente F, Viñolas X, Fidalgo Andrés ML, Fernández de la Concha J. Predictores e impacto de la adopción de programación basada en la evidencia en la incidencia de terapias del desfibrilador automático implantable. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Loughlin G, Datino T, Arenal Á, Ruiz-Granell R, Sánchez-Gómez JM, Pérez L, Martínez-Ferrer J, Alzueta J, Pérez-Lorente F, Viñolas X, Fidalgo Andrés ML, Fernández de la Concha J. Predictors of adoption and impact of evidence-based programming on the incidence of implantable cardioverter-defibrillator therapies. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2021; 74:296-302. [PMID: 32773348 DOI: 10.1016/j.rec.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES The ADVANCE III trial showed that a delayed-detection strategy reduces implantable cardioverter-defibrillator (ICD) therapies. Here, we describe the adherence to and predictors of ADVANCE adoption and compare ICD therapy rates between patients with and without ADVANCE programming. METHODS This observational retrospective study analyzed patients implanted with Medtronic ICDs included from 2005 to 2016 in a Spanish national multicenter registry (UMBRELLA database; ClinicalTrials.gov, NCT01561144). Changes in ADVANCE programming adoption were described in relation to a) publication of the ADVANCE trial, b) implementation of an "ADVANCE awareness" campaign, and c) publication of an expert consensus statement. Multivariate logistic regression identified predictors of adoption. Therapy incidence rates were compared between groups by estimating the adjusted incidence rate ratio (aIRR) using negative binomial regression. RESULTS A total of 3528 patients were included. An ADVANCE strategy was used in 20% overall and in 44% at the end of the study. ADVANCE III adoption increased after trial publication, with less growth after an "ADVANCE awareness" campaign and after expert consensus statement publication. Predictors of ADVANCE adoption were as follows: ICD device with a nominal number of intervals to detect 30/40 (aOR, 4.4; 95%CI, 3.5-5.4), implantation by an electrophysiologist (aOR, 1.7; 95%CI, 1.4-2.2), and secondary prevention (aOR, 3.2; 95%CI, 2.6-3.9). Dual-chamber ICDs (aOR, 0.6; 95%CI, 0.5-0.8) and cardiac resynchronization-defibrillators (aOR, 0.5; 95%CI, 0.4-0.7) were associated with lower adoption. ADVANCE programming was associated with reduced total therapy burden (aIRR, 0.77; 95%CI, 0.69-0.86) and fewer inappropriate shocks (aIRR, 0.66; 95%CI, 0.52-0.85). CONCLUSIONS ADVANCE adoption remains modest and can be improved through evidence-driven selection of nominal ICD settings. ADVANCE programming is associated with reduced therapy rates in real-world ICD recipients.
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Affiliation(s)
- Gerard Loughlin
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Unidad de Arritmias, Servicio de Cardiología, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - Tomás Datino
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Ángel Arenal
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ricardo Ruiz-Granell
- Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Luisa Pérez
- Servicio de Cardiología, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Javier Alzueta
- Servicio de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
| | | | - Xavier Viñolas
- Servicio de Cardiología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
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Peinado Peinado R. Adherence to optimal ICD programming: an unresolved issue. ACTA ACUST UNITED AC 2021; 74:286-289. [PMID: 33461930 DOI: 10.1016/j.rec.2020.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/22/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Rafael Peinado Peinado
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Paz, Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
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Fardman A, Ram E, Lavee J, Wieder A, Beinart R, Nof E, Peled Y. Complications of retained pacemaker hardware in heart transplant recipients: case series and review of the literature. Infection 2020; 48:635-640. [PMID: 32246271 DOI: 10.1007/s15010-020-01410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/06/2020] [Indexed: 11/26/2022]
Abstract
Heart transplantation (HT) in patients with prior cardiovascular implantable electronic devices (CIEDs) is becoming more common, in parallel with the increased use of CIEDs for patients with advanced heart failure. Complete removal of CIED components during HT is not always feasible, and it is thus surprising that the literature addressing the implications of retained CIED components is limited. Indeed, there are neither guidelines nor consensus regarding the need for removal of these CIED fragments. This issue is nonetheless becoming important in light of the increase in the percentage of HT candidates having CIEDs, on the one hand, and newer therapeutic immunosuppressive protocols with higher bacterial infection potential, on the other. Thus, with the aim to study the implications of retained CIED fragments as a step towards establishing a therapeutic approach for the unique population of HT recipients with CIED remnants, we present here a case series of HT patients with retained CIED fragments who developed complications of infections together with a review of the available literature.
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Affiliation(s)
- Alexander Fardman
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Eilon Ram
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Lavee
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Wieder
- Infectious Disease Unit, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Beinart
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Nof
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yael Peled
- Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Varma N, Jones P, Wold N, Cronin E, Stein K. How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter-Defibrillator Programming Diffuse Into Clinical Practice? Translation Assessed in a National Cohort of Patients With Implantable Cardioverter-Defibrillators ( ALTITUDE ). J Am Heart Assoc 2020; 8:e007392. [PMID: 30712432 PMCID: PMC6405582 DOI: 10.1161/jaha.117.007392] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Inappropriate implantable cardioverter-defibrillator programming can be detrimental. Whether trials/recommendations informing best implantable cardioverter-defibrillator programming (high-rate cutoff and/or extended duration of detection) influence practice is unknown. Methods and Results We measured reaction to publication of MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy; 2012) and the Consensus Statement (2015) providing generic programming parameters, in a national cohort of implantable cardioverter-defibrillator recipients, using the ALTITUDE database (Boston Scientific). Yearly changes in programmed parameters to either trial-specified or class 1 recommended parameters (≥185 beats per minute or delay ≥6 seconds) were assessed in parallel. From 2008 to 2017, 232 982 patients (aged 67±13 years; 28% women) were analyzed. Prevalence of MADIT- RIT -specific settings before publication was <1%, increasing to 13.6% in the year following. Thereafter, this increased by <6% over 5 years. Among preexisting implants (91 171), most patients (58 739 [64.4%]) underwent at least 1 in-person device reprogramming after trial publication, but <2% were reprogrammed to MADIT - RIT settings. Notably, prevalence of programming to ≥185 beats per minute or delay ≥6 seconds was increased by MADIT - RIT (57.4% in 2013 versus 40.2% at baseline), but the following publication of recommendations had minor incremental effect (73.2% in 2016 versus 70.8% in 2015). High-rate cutoff programming was favored almost 2-fold compared with extended duration throughout the test period. Practice changes demonstrated large interhospital and interstate variations. Conclusions Trial publication had an immediate effect during 1 year postpublication, but absolute penetration was low, and amplified little with time. Consensus recommendations had a negligible effect. However, generic programming was exercised more widely, and increased after trial publication, but not following recommendations.
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Marzec LN, Peterson PN, Bao H, Curtis JP, Masoudi FA, Varosy PD, Bradley SM. Use of Cardiac Resynchronization Therapy Among Eligible Patients Receiving an Implantable Cardioverter Defibrillator: Insights From the National Cardiovascular Data Registry Implantable Cardioverter Defibrillator Registry. JAMA Cardiol 2019; 2:561-565. [PMID: 28122073 DOI: 10.1001/jamacardio.2016.5388] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Cardiac resynchronization therapy (CRT) reduces the risk for mortality and heart failure-related events in select patients. Little is known about the use of CRT in combination with an implantable cardioverter defibrillator (ICD) in patients who are eligible for this therapy in clinical practice. Objective To (1) identify patient, clinician, and hospital characteristics associated with CRT defibrillator (CRT-D) use and (2) determine the extent of hospital-level variation in the use of CRT-D among guideline-eligible patients undergoing ICD placement. Design, Setting, and Participants Multicenter retrospective cohort from 1428 hospitals participating in the National Cardiovascular Data Registry ICD Registry between April 1, 2010, and June 30, 2014. Adult patients meeting class I or IIa guideline recommendations for CRT at the time of device implantation were included in this study. Main Outcomes and Measures Implantation of an ICD with or without CRT. Results A total of 63 506 eligible patients (88.6%) received CRT-D at the time of device implantation. The mean (SD) ages of those in the ICD and CRT-D groups were 67.9 (12.2) years and 68.4 (11.5) years, respectively. In hierarchical multivariable models, black race was independently associated with lower use of CRT-D (odds ratio [OR], 0.77; 95% CI, 0.71-0.83) as was nonprivate insurance (OR, 0.90; 95% CI, 0.85-0.95 for Medicare and OR, 0.73; 95% CI, 0.65-0.82 for Medicaid). Clinician factors associated with greater CRT-D use included clinician implantation volume (OR, 1.01 per 10 additional devices implanted; 95% CI, 1.01-1.01) and electrophysiology training (OR, 3.13 as compared with surgery-boarded clinicians; 95% CI, 2.50-3.85). At the hospital level, the overall median risk-standardized rate of CRT-D use was 79.9% (range, 26.7%-100%; median OR, 2.08; 95% CI, 1.99-2.18). Conclusions and Relevance In a national cohort of patients eligible for CRT-D at the time of device implantation, nearly 90% received a CRT-D device. However, use of CRT-D differed by race and implanting operator characteristics. After accounting for these factors, the use of CRT-D continued to vary widely by hospital. Addressing disparities and variation in CRT-D use among guideline-eligible patients may improve patient outcomes.
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Affiliation(s)
| | - Pamela N Peterson
- University of Colorado School of Medicine, Aurora2Denver Health Medical Center, Denver, Colorado
| | - Haikun Bao
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | - Paul D Varosy
- University of Colorado School of Medicine, Aurora4Veterans Affairs Eastern Colorado Health Care System, Denver
| | - Steven M Bradley
- University of Colorado School of Medicine, Aurora4Veterans Affairs Eastern Colorado Health Care System, Denver
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12
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Mistry A, Vali Z, Taher A, Sidhu B, Li X, Newton M, Ng GA. Consideration for primary prevention implantable cardioverter defibrillators differ between specialities. Postgrad Med J 2019; 95:205-209. [PMID: 31097576 DOI: 10.1136/postgradmedj-2019-136447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 04/18/2019] [Accepted: 05/04/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE Implantable cardioverter defibrillator (ICD) implantation rates remain variable despite established guideline recommendations. This study aims to assess whether being managed by a cardiologist has an impact on whether patients are considered for an ICD for primary prevention of sudden cardiac death. DESIGN/METHODS Single-centre, retrospective, observational study of patients identified to have severe left ventricular systolic dysfunction (LVSD) on echocardiography (n = 129) between 1 and 30 June 2016 with cross-sectional assessment at 1 year. An assessment of ICD consideration at 1 year following the echocardiogram was documented, in addition to the specialty of the managing physician (group 1-electrophysiologist/heart failure specialist; group 2-all other cardiologists; group 3-non-cardiologist). RESULTS 129/1173 (11%) transthoracic echocardiographies (s) were identified to have severe LVSD. 52 (40%), 37 (29%) and 40 (31%) were managed by group 1, group 2 and group 3, respectively. Mean age was 74.7 (±12.6) years with a predominance of male gender (70.5%). An ICD was not considered in 47.3%. Those managed by a cardiologist were more likely to be considered for an ICD than a non-cardiologist (63.9% vs 30.0%; OR 4.0, 95% CI 1.8 to 8.8, p = 0.001) with a greater survival at 1 year (89.9% vs 52.5%, OR 8.1 95% CI 3.2 to 20.4, p < 0.001). Group 1 were more likely to consider ICD than group 2 cardiologists (75.0% vs 45.9%; OR 3.5; 95% CI 1.4 to 8.7, p = 0.005). CONCLUSION There is significant variation between cardiologists and non-cardiologists, as well as within different cardiology subspecialists, when considering the option of ICD therapy for primary prevention.
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Affiliation(s)
- Amar Mistry
- Department of Cardiovascular Science, University of Leicester, Leicester, UK .,Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - Zakariyya Vali
- Department of Cardiovascular Science, University of Leicester, Leicester, UK.,Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - Abu Taher
- Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - Bharat Sidhu
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - Xin Li
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - Michelle Newton
- Department of Cardiovascular Science, University of Leicester, Leicester, UK
| | - Ghulam Andre Ng
- Department of Cardiovascular Science, University of Leicester, Leicester, UK.,Department of Cardiology, Glenfield Hospital, Leicester, UK
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Lee JH, Lee SR, Choi EK, Jeong J, Park HD, You SJ, Lee SS, Oh S. Temporal Trends of Cardiac Implantable Electronic Device Implantations: a Nationwide Population-based Study. Korean Circ J 2019; 49:841-852. [PMID: 31074230 PMCID: PMC6713826 DOI: 10.4070/kcj.2018.0444] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 12/28/2022] Open
Abstract
Background and Objectives Implantation of cardiac implantable electronic devices (CIED), including permanent pacemakers (PM), implantable cardioverter-defibrillators (ICD), and cardiac resynchronization therapy (CRT) devices, has increased significantly over the past several years. However, limited data exists regarding temporal trends of CIED implantations in Asian population. This study aimed to investigate temporal trends of CIED treatment in Korea. Methods Using the National Health Insurance Service database of the entire Korean adult population, temporal trends of CIED procedures between 2009 and 2016 were evaluated. Additionally, temporal changes in the prevalence of patients' comorbidities were evaluated. Results A total of 35,421 CIED procedures (new implantations: 27,771, replacements: 7,650) were performed during the study period. The mean age of new CIED recipients and the prevalence of comorbidities, including hypertension, diabetes mellitus, heart failure, stroke, and atrial fibrillation, increased substantially with time. Compared to 2009, the number of new implantations of PM, ICD, and CRT devices increased by 2.0 (1,977 to 3,910), 3.6 (230 to 822), and 4.9 (44 to 217) times in 2016, respectively. The annual new implantation rate of CIED also increased accordingly (5.1 to 9.3 for PM, 0.6 to 1.9 for ICD, and 0.1 to 0.5 for CRT devices, per 100,000 persons). Conclusions The number of CIED implantation increased substantially from 2009 to 2016 in Korea. Also, the patients with CIED have been changed to be older and have more comorbidities. Therefore, the burden of health care cost in patients with CIED would be expected to increase in the future.
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Affiliation(s)
- Ji Hyun Lee
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | | | | | | | - Sang Soo Lee
- Medtronic Korea, Ltd., Seoul, Korea.,Graduate School for Medical Device Management and Research, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Chia YMF, Teng THK, Tan ESJ, Tay WT, Richards AM, Chin CWL, Shimizu W, Park SW, Hung CL, Ling LH, Ngarmukos T, Omar R, Siswanto BB, Narasimhan C, Reyes EB, Yu CM, Anand I, MacDonald MR, Yap J, Zhang S, Finkelstein EA, Lam CSP. Disparity Between Indications for and Utilization of Implantable Cardioverter Defibrillators in Asian Patients With Heart Failure. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.116.003651. [PMID: 29150533 DOI: 10.1161/circoutcomes.116.003651] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICDs) are lifesaving devices for patients with heart failure (HF) and reduced ejection fraction. However, utilization and determinants of ICD insertion in Asia are poorly defined. We determined the utilization, associations of ICD uptake, patient-perceived barriers to device therapy and, impact of ICDs on mortality in Asian patients with HF. METHODS AND RESULTS Using the prospective ASIAN-HF (Asian Sudden Cardiac Death in Heart Failure) registry, 5276 patients with symptomatic HF and reduced ejection fraction (HFrEF) from 11 Asian regions and across 3 income regions (high: Hong Kong, Japan, Korea, Singapore, and Taiwan; middle: China, Malaysia, and Thailand; and low: India, Indonesia, and Philippines) were studied. ICD utilization, clinical characteristics, as well as device perception and knowledge, were assessed at baseline among ICD-eligible patients (EF ≤35% and New York Heart Association Class II-III). Patients were followed for the primary outcome of all-cause mortality. Among 3240 ICD-eligible patients (mean age 58.9±12.9 years, 79.1% men), 389 (12%) were ICD recipients. Utilization varied across Asia (from 1.5% in Indonesia to 52.5% in Japan) with a trend toward greater uptake in regions with government reimbursement for ICDs and lower out-of-pocket healthcare expenditure. ICD (versus non-ICD) recipients were more likely to be older (63±11 versus 58±13 year; P<0.001), have tertiary (versus ≤primary) education (34.9% versus 18.1%; P<0.001) and be residing in a high (versus low) income region (64.5% versus 36.5%; P<0.001). Among 2000 ICD nonrecipients surveyed, 55% were either unaware of the benefits of, or needed more information on, device therapy. ICD implantation reduced risks of all-cause mortality (hazard ratio, 0.71; 95% confidence interval, 0.52-0.97) and sudden cardiac deaths (hazard ratio, 0.33; 95% confidence interval, 0.14-0.79) over a median follow-up of 417 days. CONCLUSIONS ICDs reduce mortality risk, yet utilization in Asia is low; with disparity across geographic regions and socioeconomic status. Better patient education and targeted healthcare reforms in extending ICD reimbursement may improve access. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov/ct2/show/NCT01633398. Unique identifier: NCT01633398.
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Affiliation(s)
- Yvonne May Fen Chia
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Tiew-Hwa Katherine Teng
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Eugene S J Tan
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Wan Ting Tay
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - A Mark Richards
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Calvin Woon Loong Chin
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Wataru Shimizu
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Sang Weon Park
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Chung-Lieh Hung
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Lieng H Ling
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Tachapong Ngarmukos
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Razali Omar
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Bambang B Siswanto
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Calambur Narasimhan
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Eugene B Reyes
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Cheuk-Man Yu
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Inder Anand
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Michael R MacDonald
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Jonathan Yap
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Shu Zhang
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Eric A Finkelstein
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.)
| | - Carolyn S P Lam
- From the Department of Medicine, Duke-NUS Medical School, Singapore (Y.M.F.C., C.W.L.C., E.A.F., C.S.P.L.); Department of Cardiology, National Heart Centre Singapore (T.-H.K.T., W.T.T., C.W.L.C., J.Y., C.S.P.L.); School of Population Health, The University of Western Australia, Perth (T.-H.K.T.); Department of Cardiology, National University Heart Centre Singapore (E.S.J.T., A.M.R., L.H.L.); Cardiovascular Research Institute, National University of Singapore (A.M.R., L.H.L., C.S.P.L.); Christchurch Heart Institute, University of Otago, New Zealand (A.M.R.); Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.); Department of Cardiology, Sejong General Hospital, Bucheon, Korea (S.W.P.); Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Cardiovascular Disease, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (T.N.); National Heart Institute, Institut Jantung Negara, Kuala Lumpur, Malaysia (R.O.); Department of Cardiology, National Cardiovascular Center Universitas Indonesia, Jakarta (B.B.S.); Department of Cardiology, CARE Hospital, Hyderabad, Telangana, India (C.N.); Department of Cardiology, Manila Doctors Hospital, Philippines (E.B.R.); Department of Cardiology, Prince of Wales Hospital, The Chinese University of Hong Kong, The People's Republic of China (C.-M.Y.); Department of Cardiology, Hong Kong Baptist Hospital, The People's Republic of China (C.-M.Y.); Department of Cardiology, VA Medical Center, University of Minnesota, MN (I.A.); Department of Cardiology, Changi General Hospital, Singapore (M.R.M.); and Department of Cardiology, Fuwai Hospital, Beijing, China (S.Z.).
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Russo AM. Gaps in physician knowledge are associated with under-referral for evidence-based implantable cardioverter defibrillator therapy: How can we improve care? J Cardiovasc Electrophysiol 2017; 28:1342-1344. [PMID: 28862779 DOI: 10.1111/jce.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 08/28/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Andrea M Russo
- Cooper Medical School of Rowan University, Camden, NJ, USA
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16
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Varma N, Mittal S, Prillinger JB, Snell J, Dalal N, Piccini JP. Survival in Women Versus Men Following Implantation of Pacemakers, Defibrillators, and Cardiac Resynchronization Therapy Devices in a Large, Nationwide Cohort. J Am Heart Assoc 2017; 6:JAHA.116.005031. [PMID: 28490521 PMCID: PMC5524072 DOI: 10.1161/jaha.116.005031] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Whether outcomes differ between sexes following treatment with pacemakers (PM), implantable cardioverter defibrillators, and cardiac resynchronization therapy (CRT) devices is unclear. Methods and Results Consecutive US patients with newly implanted PM, implantable cardioverter defibrillators, and CRT devices from a large remote monitoring database between 2008 and 2011 were included in this observational cohort study. Sex‐specific all‐cause survival postimplant was compared within each device type using a multivariable Cox proportional hazards model, stratified on age and adjusted for remote monitoring utilization and ZIP‐based socioeconomic variables. A total of 269 471 patients were assessed over a median 2.9 [interquartile range, 2.2, 3.6] years. Unadjusted mortality rates (MR; deaths/100 000 patient‐years) were similar between women versus men receiving PMs (n=115 076, 55% male; MR 4193 versus MR 4256, respectively; adjusted hazard ratio, 0.87; 95% CI, 0.84–0.90; P<0.001) and implantable cardioverter defibrillators (n=85 014, 74% male; MR 4417 versus MR 4479, respectively; adjusted hazard ratio, 0.98; 95% CI, 0.93–1.02; P=0.244). In contrast, survival was superior in women receiving CRT defibrillators (n=61 475, 72% male; MR 5270 versus male MR 7175; adjusted hazard ratio, 0.73; 95% CI, 0.70–0.76; P<0.001) and also CRT pacemakers (n=7906, 57% male; MR 5383 versus male MR 7625, adjusted hazard ratio, 0.69; 95% CI, 0.61–0.78; P<0.001). This relative difference increased with time. These results were unaffected by age or remote monitoring utilization. Conclusions Women accounted for less than 30% of high‐voltage implants and fewer than half of low‐voltage implants in a large, nation‐wide cohort. Survival for women and men receiving implantable cardioverter defibrillators and PMs was similar, but dramatically greater for women receiving both defibrillator‐ and PM‐based CRT.
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17
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Moen EL, Austin AM, Bynum JP, Skinner JS, O'Malley AJ. An analysis of patient-sharing physician networks and implantable cardioverter defibrillator therapy. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2016; 16:132-153. [PMID: 27597812 PMCID: PMC5010235 DOI: 10.1007/s10742-016-0152-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 11/25/2022]
Abstract
The application of social network analysis to the organization of healthcare delivery is a relatively new area of research that may not be familiar to health services statisticians and other methodologists. We present a methodological introduction to social network analysis with a case study of physicians' adherence to clinical guidelines regarding use of implantable cardioverter defibrillators (ICDs) for the prevention of sudden cardiac death. We focus on two hospital referral regions (HRRs) in Indiana, Gary and South Bend, characterized by different rates of evidence-based ICD use (86% and 66%, respectively). Using Medicare Part B claims, we construct a network of physicians who care for cardiovascular disease patients based on patient-sharing relationships. Approaches for weighting physician dyads and aggregating physician dyads by hospital are discussed. Then, we obtain a set of weighted network statistics for the positions of hospitals in their referral region, global statistics for the physician network within each hospital, and of the network positions of individual physicians within hospitals, providing the mathematical specification and sociological intuition underlying each measure. We find that adjusting for network measures can reduce the observed differences between referral regions for evidence-based ICD therapy. This study supports previous reports on how variation in physician network structure relates to utilization of care, and motivates future work using physician network measures to examine variation in evidence-based medicine.
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Affiliation(s)
- Erika L. Moen
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, One Medical Center Dr., Lebanon, NH 03756
| | - Andrea M. Austin
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, One Medical Center Dr., Lebanon, NH 03756
| | - Julie P. Bynum
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, One Medical Center Dr., Lebanon, NH 03756
- The Department of Medicine, Geisel School of Medicine at Dartmouth, One Medical Center Dr., Lebanon, NH 03756
| | - Jonathan S. Skinner
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, One Medical Center Dr., Lebanon, NH 03756
- Department of Economics, Dartmouth College, Hanover NH 03755
| | - A. James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, One Medical Center Dr., Lebanon, NH 03756
- The Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, One Medical Center Dr., Lebanon, NH 03756
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18
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Boriani G, Berti E, Belotti LMB, Biffi M, Carboni A, Bandini A, Casali E, Tomasi C, Toselli T, Baraldi P, Bottoni N, Barbato G, Sassone B. Cardiac resynchronization therapy: implant rates, temporal trends and relationships with heart failure epidemiology. J Cardiovasc Med (Hagerstown) 2014; 15:147-54. [PMID: 23811841 DOI: 10.2459/jcm.0b013e3283638d90] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Consensus guidelines define indications for cardiac resynchronization therapy (CRT), but the variability in implant rates in 'real world' clinical practice, as well as the relationship with the epidemiology of heart failure are not defined. METHODS AND RESULTS In Emilia-Romagna, an Italian region with around 4.4 million inhabitants, a registry was instituted to collect data on implanted devices for CRT, with (CRT-D) or without defibrillation (CRT-P) capabilities. Data from all consecutive patients resident in this region who underwent a first implant of a CRT device in years 2006-2010 were collected and standardized (considering each of the nine provinces of the region). The number of CRT implants increased progressively, with a 71% increase in 2010 compared to 2006. Between 84 and 90% of implants were with CRT-D devices. The variability in standardized implant rates among the provinces was substantial and the ratio between the provinces with the highest and the lowest implant rates was always greater than 2. Considering prevalent cases of heart failure in the period 2006-2010, the proportion of patients implanted with CRT per year ranged between 0.23 and 0.30%. CONCLUSIONS The application in 'real world' clinical practice of CRT in heart failure is quite heterogeneous, with substantial variability even among areas belonging to the same region, with the need to make the access to this treatment more equitable. Despite the increased use of CRT, its overall rate of adoption is low, if a population of prevalent heart failure patients is selected on the basis of administrative data on hospitalizations.
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Affiliation(s)
- Giuseppe Boriani
- aInstitute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi bAgency for Health and Social Care of Emilia-Romagna, Bologna cDivision of Cardiology, Parma dDivision of Cardiology, Forli' eDivision of Cardiology, Modena fDivision of Cardiology, Ravenna gDivision of Cardiology, Ferrara hDivision of Cardiology, Baggiovara (MO) iDivision of Cardiology, Reggio Emilia jDivision of Cardiology, Maggiore Hospital, Bologna kOspedale SS Annunziata Cento, AUSL Ferrara, Cento (FE), Italy
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Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, Hohnloser SH, Indik J, Lee R, Mehra MR, Menon V, Page RL, Shen WK, Slotwiner DJ, Stevenson LW, Varosy PD, Welikovitch L. HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials. J Am Coll Cardiol 2014; 64:1143-77. [DOI: 10.1016/j.jacc.2014.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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HRS/ACC/AHA Expert Consensus Statement on the Use of Implantable Cardioverter-Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials. Heart Rhythm 2014; 11:1271-303. [DOI: 10.1016/j.hrthm.2014.03.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Indexed: 01/16/2023]
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21
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Kusumoto FM, Calkins H, Boehmer J, Buxton AE, Chung MK, Gold MR, Hohnloser SH, Indik J, Lee R, Mehra MR, Menon V, Page RL, Shen WK, Slotwiner DJ, Stevenson LW, Varosy PD, Welikovitch L. HRS/ACC/AHA expert consensus statement on the use of implantable cardioverter-defibrillator therapy in patients who are not included or not well represented in clinical trials. Circulation 2014; 130:94-125. [PMID: 24815500 DOI: 10.1161/cir.0000000000000056] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Fred M Kusumoto
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Hugh Calkins
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - John Boehmer
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Alfred E Buxton
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Mina K Chung
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Michael R Gold
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Stefan H Hohnloser
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Julia Indik
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Richard Lee
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Mandeep R Mehra
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Venu Menon
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Richard L Page
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Win-Kuang Shen
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - David J Slotwiner
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Lynne Warner Stevenson
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Paul D Varosy
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
| | - Lisa Welikovitch
- From Mayo Clinic Jacksonville, Jacksonville, Florida, John Hopkins Hospital, Baltimore, Maryland, Pennsylvania State Hershey Medical Center, Hershey, Pennsylvania, Beth Israel Deaconess Medical Center, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, Medical University of South Carolina, Charleston, South Carolina, J.W. Goethe University, Frankfurt, Germany, University of Arizona, Sarver Heart Center, Tucson, Arizona, St. Louis University, St. Louis, Missouri, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, Cleveland Clinic, Cleveland, Ohio, University of Wisconsin School of Medicine and Public Health, Mayo Clinic College of Medicine, Phoenix, Arizona, Hofstra North Shore - Long Island Jewish School of Medicine, Cardiac Electrophysiology Lab, New Hyde Park, New York, Brigham & Women's Hospital, Boston, Massachusetts, VA Eastern Colorado Health Care System, Cardiology, Denver, Colorado, and Department of Cardiac Services, University of Calgary, Alberta, Canada
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Zhang Y, Kennedy R, Blasco-Colmenares E, Butcher B, Norgard S, Eldadah Z, Dickfeld T, Ellenbogen KA, Marine JE, Guallar E, Tomaselli GF, Cheng A. Outcomes in African Americans undergoing cardioverter-defibrillator implantation for primary prevention of sudden cardiac death: findings from the Prospective Observational Study of Implantable Cardioverter-Defibrillators (PROSE-ICD). Heart Rhythm 2014; 11:1377-83. [PMID: 24793459 DOI: 10.1016/j.hrthm.2014.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) reduce the risk of death in patients with left ventricular dysfunction. Little is known regarding the benefit of this therapy in African Americans (AAs). OBJECTIVE The purpose of this study was to determine the association between AA race and outcomes in a cohort of primary prevention ICD patients. METHODS We conducted a prospective cohort study of patients with systolic heart failure who underwent ICD implantation for primary prevention of sudden cardiac death. The primary end-point was appropriate ICD shock defined as a shock for rapid ventricular tachyarrhythmias. The secondary end-point was all-cause mortality. RESULTS There were 1189 patients (447 AAs and 712 non-AAs) enrolled. Over a median follow-up of 5.1 years, a total of 137 patients experienced an appropriate ICD shock, and 343 died (294 of whom died without receiving an appropriate ICD shock). The multivariate adjusted hazard ratio (95% confidence interval) comparing AAs vs non-AAs were 1.24 (0.96-1.59) for all-cause mortality, 1.33 (1.02, 1.74) for all-cause mortality without receiving appropriate ICD shock, and 0.78 (0.51, 1.19) for appropriate ICD shock. Ejection fraction, diabetes, and hypertension appeared to explain 24.1% (10.1%-69.5%), 18.7% (5.3%-58.0%), and 13.6% (3.8%-53.6%) of the excess risk of mortality in AAs, with a large proportion of the mortality difference remaining unexplained. CONCLUSION In patients with primary prevention ICDs, AAs had an increased risk of dying without receiving an appropriate ICD shock compared to non-AAs.
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Affiliation(s)
- Yiyi Zhang
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Barbara Butcher
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sanaz Norgard
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eliseo Guallar
- Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Gordon F Tomaselli
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan Cheng
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Hübinette C, Lund LH, Gadler F, Ståhlberg M. Awareness of indications for device therapy among a broad range of physicians: a survey study. ACTA ACUST UNITED AC 2014; 16:1580-6. [DOI: 10.1093/europace/eut416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Gupta A, Gholami P, Turakhia MP, Friday K, Heidenreich PA. Clinical reminders to providers of patients with reduced left ventricular ejection fraction increase defibrillator referral: a randomized trial. Circ Heart Fail 2013; 7:140-5. [PMID: 24319096 DOI: 10.1161/circheartfailure.113.000753] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients who are candidates for implantable cardioverter defibrillators (ICDs) are not referred for potential implantation. We sought to determine if a simple provider reminder would increase referrals. METHODS AND RESULTS We identified consecutive patients from January 2007 through July 2010 in the VA Palo Alto Health Care System with a left ventricular ejection fraction<35% on echocardiography. Patients were excluded using available administrative data only (no chart review) if they were known to have an ICD, if they were ≥80 years old, or if they did not have a current primary care or cardiology provider within the system. We randomized patients to no intervention or a clinical note to the provider in the medical record. The outcomes were referral for consideration of defibrillator implantation (primary) and documented discussion (secondary). Of 330 patients with left ventricular ejection fraction≤35%, 128 were known to have an ICD, 85 were no longer followed in the healthcare system, and 28 were ≥80 years old, leaving 89 patients to be randomized. Forty-six patients were randomized to intervention and 43 to control. Eleven of 46 (24%) intervention patients were referred for consideration of ICD implantation during the following 6 months versus 1 of 43 (2%) control patients (P=0.004). Overall, 31 of 46 (67%) intervention patients versus 19 of 43 (44%) control patients had documentation discussing potential candidacy for defibrillators (P=0.05). CONCLUSIONS In patients with low left ventricular ejection fraction, a simple electronic medical record-based intervention directed to their providers improved the rates of referral for ICD implantation. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01217827.
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Affiliation(s)
- Anurag Gupta
- Medical Service, VA Palo Alto Health Care System, Palo Alto, CA
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Russo AM, Stainback RF, Bailey SR, Epstein AE, Heidenreich PA, Jessup M, Kapa S, Kremers MS, Lindsay BD, Stevenson LW. ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Heart Rhythm 2013; 10:e11-58. [PMID: 23473952 DOI: 10.1016/j.hrthm.2013.01.008] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Indexed: 01/27/2023]
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ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2013; 61:1318-68. [PMID: 23453819 DOI: 10.1016/j.jacc.2012.12.017] [Citation(s) in RCA: 266] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Markowitz SM. Guidelines for implantation of primary prevention defibrillators: Who is listening? Heart Rhythm 2012; 9:882-3. [DOI: 10.1016/j.hrthm.2012.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Indexed: 11/30/2022]
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Castellanos JM, Smith LM, Varosy PD, Dehlendorf C, Marcus GM. Referring physicians' discordance with the primary prevention implantable cardioverter-defibrillator guidelines: a national survey. Heart Rhythm 2012; 9:874-81. [PMID: 22306794 DOI: 10.1016/j.hrthm.2012.01.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND The American College of Cardiology, the American Heart Association, and the Heart Rhythm Society guidelines provide patient selection criteria for primary prevention implantable cardioverter-defibrillators (ICDs). For unknown reasons, guideline-discordant practice is common. OBJECTIVE To determine referring physicians' concordance with the primary prevention ICD guidelines. METHODS We mailed a survey regarding ICD guidelines and individual practice characteristics to a random national sample of 3000 physicians selected from the American Medical Association Masterfile-one-third each specializing in family medicine, internal medicine, and general cardiology. RESULTS Sixty-four percent with correct contact information responded. Three hundred ninety-five (28%; 95% confidence interval [CI] 25%-30%) respondents never refer patients with the intent of consideration for a primary prevention ICD, including 7% (95% CI 5%-10%) of cardiologists. Two hundred twelve (15%; 95% CI 13%-17%) believe ventricular arrhythmias are required before a primary prevention ICD is indicated; 525 (36%; 95% CI 34%-39%) believe that an ejection fraction of >40% warrants a primary prevention ICD; and 361 (25%; 95% CI 23%-27%) would refer a patient for a primary prevention ICD within 40 days of a myocardial infarction. In multivariate analyses, family practice physicians and physicians residing in the western United States most often provided guideline-discordant answers, while cardiologists and those who refer to an electrophysiologist most often provided guideline-concordant answers. Primary care physicians who manage heart failure patients without referral to a subspecialist were not more likely to provide guideline-concordant answers. CONCLUSIONS Answers discordant with the primary prevention ICD guidelines were common, suggesting that referring physician beliefs are an important barrier to appropriate patient referrals for primary prevention ICD implantation.
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Affiliation(s)
- Jorge M Castellanos
- Department of Medicine, University of California, San Francisco, CA 94143-1354, USA
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Russo AM. The reality of implantable cardioverter-defibrillator longevity: what can be done to improve cost-effectiveness? Heart Rhythm 2011; 9:520-1. [PMID: 22172319 DOI: 10.1016/j.hrthm.2011.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Indexed: 10/14/2022]
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MEHRA MANDEEPR, ALBERT NANCYM, CURTIS ANNEB, GHEORGHIADE MIHAI, HEYWOOD JTHOMAS, LIU YANG, O’CONNOR CHRISTOPHERM, REYNOLDS DWIGHT, WALSH MARYNORINE, YANCY CLYDEW, FONAROW GREGGC. Factors Associated with Improvement in Guideline-Based Use of ICDs in Eligible Heart Failure Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:135-45. [DOI: 10.1111/j.1540-8159.2011.03279.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Eapen ZJ, Peterson ED, Fonarow GC, Sanders GD, Yancy CW, Sears SF, Carlson MD, Curtis AB, Hall LL, Hayes DL, Hernandez AF, Mirro M, Prystowsky E, Russo AM, Thomas KL, Al-Khatib SM. Quality of care for sudden cardiac arrest: Proposed steps to improve the translation of evidence into practice. Am Heart J 2011; 162:222-31. [PMID: 21835281 DOI: 10.1016/j.ahj.2011.04.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 04/26/2011] [Indexed: 11/16/2022]
Abstract
Sudden cardiac arrest (SCA) is the most common cause of death in the United States. Despite national guidelines, patients at risk for SCA often fail to receive evidence-based therapies. Racial and ethnic minorities and women are at particularly high risk for undertreatment. To address the persistent challenges in improving the quality of care for SCA, the Duke Center for the Prevention of Sudden Cardiac Death at the Duke Clinical Research Institute (Durham, NC) reconvened the Sudden Cardiac Arrest Thought Leadership Alliance. Experts from clinical cardiology, cardiac electrophysiology, health policy and economics, the US Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Agency for Health Care Research and Quality, and device and pharmaceutical manufacturers discussed the development of SCA educational tools for patients and providers, mechanisms of implementing successful tools to help providers identify patients in their practice at risk for SCA, disparities in SCA prevention, and performance measures related to SCA care. This article summarizes the discussions held at this meeting.
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Affiliation(s)
- Zubin J Eapen
- Duke Clinical Research Institute, Durham, NC 27715, USA
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Indications for implantable cardioverter-defibrillator placement in ischemic cardiomyopathy and after myocardial infarction. Curr Heart Fail Rep 2011; 8:252-9. [PMID: 21769565 DOI: 10.1007/s11897-011-0069-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Dramatic reductions in the rate of sudden cardiac death due to use of implantable cardioverter-defibrillators (ICDs) have been well-established in several large randomized clinical trials including patients with left ventricular dysfunction after myocardial infarction. This article reviews the literature regarding ICD utilization in the postinfarction population, with a strong emphasis on recent clinical trials. The most current indications for, and timing of, ICD implantation postinfarction also are summarized.
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Santini M, Pignalberi C. Timing of defibrillator implant after acute myocardial infarction: what's new? Europace 2011; 13:455-7. [DOI: 10.1093/europace/euq457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Robinson MR, Epstein AE, Callans DJ. Secondary prevention in heart failure. Heart Fail Clin 2011; 7:185-94, vii-viii. [PMID: 21439497 DOI: 10.1016/j.hfc.2010.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although most recent investigations into sudden cardiac death prevention in heart failure patients have been focused on primary prevention, secondary indications for defibrillators and medical therapy remain vitally important in this complex patient group. Antiarrhythmic therapy is currently used primarily as adjuvant therapy to implantable defibrillators. Secondary prophylaxis defibrillator trials have shown clear benefit in preventing recurrent sudden cardiac death, despite concern over inappropriate shocks and the potential detrimental effects of appropriate shocks. Device programming for secondary prophylaxis can help ameliorate these issues. This article discusses these issues as well as the continued underuse of defibrillators in specific populations.
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Affiliation(s)
- Melissa R Robinson
- Electrophysiology Section, Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Mitchell JE, Ferdinand KC, Watson KE, Wenger NK, Watkins LO, Flack JM, Gavin JR, Reed JW, Saunders E, Wright JT. Treatment of Heart Failure in African Americans— A Call to Action. J Natl Med Assoc 2011; 103:86-98. [DOI: 10.1016/s0027-9684(15)30257-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Daniel B. Kramer
- From the CardioVascular Institute, Beth Israel Deaconess Medical Center; and Harvard Medical School, Boston, Mass
| | - Mark E. Josephson
- From the CardioVascular Institute, Beth Israel Deaconess Medical Center; and Harvard Medical School, Boston, Mass
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Kong MH, Peterson ED, Fonarow GC, Sanders GD, Yancy CW, Russo AM, Curtis AB, Sears SF, Thomas KL, Campbell S, Carlson MD, Chiames C, Cook NL, Hayes DL, LaRue M, Hernandez AF, Lyons EL, Al-Khatib SM. Addressing disparities in sudden cardiac arrest care and the underutilization of effective therapies. Am Heart J 2010; 160:605-18. [PMID: 20934553 PMCID: PMC2956019 DOI: 10.1016/j.ahj.2010.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 07/09/2010] [Indexed: 02/06/2023]
Abstract
Sudden cardiac arrest (SCA) is the most common cause of death in the Unites States. Despite its major impact on public health, significant challenges exist at the patient, provider, public, and policy levels with respect to raising more widespread awareness and understanding of SCA risks, identifying patients at risk for SCA, addressing barriers to SCA care, and eliminating disparities in SCA care and outcomes. To address many of these challenges, the Duke Center for the Prevention of Sudden Cardiac Death at the Duke Clinical Research Institute (Durham, NC) held a think tank meeting on December 7, 2009, convening experts on this issue from clinical cardiology, cardiac electrophysiology, health policy and economics, the US Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Agency for Health Care Research and Quality, and device and pharmaceutical manufacturers. The specific goals of the meeting were to examine existing educational tools on SCA for patients, health care providers, and the public and explore ways to enhance and disseminate these tools; to propose a framework for improved identification of patients at risk of SCA; and to review the latest data on disparities in SCA care and explore ways to reduce these disparities. This article summarizes the discussions that occurred at the meeting.
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Boriani G, Berti E, Biffi M, Marino M, Sassone B, Villani GQ, Bottoni N, Malavasi VL, Melandri F, Barbato G, Talamonti E, Marconi M. Implantable electrical devices for prevention of sudden cardiac death: data on implant rates from a 'real world' regional registry. Europace 2010; 12:1224-1230. [DOI: 10.1093/europace/euq176] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Role of the Automatic Implantable Cardioverter Defibrillator in the Post-myocardial Infarction Patient. CURRENT CARDIOVASCULAR RISK REPORTS 2010. [DOI: 10.1007/s12170-010-0112-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Quin EM, Gold MR. Implantable device use in systolic heart failure: lessons learned from IMPROVE HF. Heart Rhythm 2009; 6:1735-6. [PMID: 19959120 DOI: 10.1016/j.hrthm.2009.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Indexed: 11/19/2022]
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