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Europace Advance Access originally published online on March 3, 2008
Europace 2008 10(4):453-457; doi:10.1093/europace/eun042
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

ICD FOR PRIMARY PREVENTION: MORE IMPLANTS ARE NEEDED

Estimation of the requirement for implantable cardioverter defibrillators for the primary prevention of sudden cardiac death post-myocardial infarction based on UK national guidelines (2006)

P.A. Scott1,*, S. Gorman2, N.P. Andrews2, P.R. Roberts1 and P.R. Kalra2

1 Wessex Cardiothoracic Unit, Southampton University Hospital, Tremona Road, Southampton SO16 6YD, UK; 2 Department of Cardiology, Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK

Aims: To assess the impact of the new UK National Institute for Health and Clinical Excellence (NICE) guidelines on the incidence of implantable cardioverter defibrillator (ICD) indications for the primary prevention of sudden cardiac death following myocardial infarction (MI).

Methods and results: We performed a retrospective single centre study in a District General Hospital. The transthoracic echocardiogram reports of all patients with a discharge diagnosis of MI during a 6-month period were studied. We reviewed the notes of all patients with an estimated left ventricular ejection fraction (LVEF) of <35% and used UK national guidance to assess the incidence of potential ICD indications. Five hundred and forty-six patients had a discharge diagnosis of MI. Fifty had estimated LVEF <35% and 8–11 of these met the NICE post-MI primary prevention criteria for ICD implantation. This gives an estimated incidence based upon our local population of 29–39 patients/million/year. Most of these patients (64–88%) were identified purely by ECG criteria (QRS > 120 ms) and LVEF.

Conclusion: The latest published UK ICD data give a new implantation rate of ~40/million/year. Combining our results with published data for NICE secondary prevention indications gives a combined ICD indication incidence of ~105–115/million/year. This suggests there is currently significant under-provision of ICD therapy in the UK.

Key Words: Implantable cardioverter defibrillators, Guidelines, National Institute for Health and Clinical Excellence, Sudden cardiac death

* Corresponding author. Tel: +44 2380 798693; fax: +44 2380 794036.E-mail address: paul.andrew.scott{at}btinternet.com

Manuscript submitted 4 December 2007. Accepted after revision 2 February 2008.


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