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Europace Advance Access originally published online on September 3, 2009
Europace 2009 11(10):1313-1316; doi:10.1093/europace/eup236
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

ICD

A national survey of clinician's knowledge of and attitudes towards implantable cardioverter defibrillators

Ben McHale1, Scott A. Harding2, Nigel A. Lever3,4 and Peter D. Larsen*

1 Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand; 2 Cardiology Department, Wellington Hospital, Wellington, New Zealand; 3 Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; 4 Department of Medicine, University of Auckland, Auckland, New Zealand

Aims: This study surveyed referring clinicians to identify barriers that may contribute to New Zealand's low national implantable cardioverter defibrillator (ICD) implant rate.

Methods: We conducted a telephone survey of 100 cardiologists and general physicians working at 30 different New Zealand hospitals who routinely manage patients with ischaemic heart disease and heart failure.

Results: The majority of those surveyed (76%) rated their knowledge as satisfactory or better, although only 62% reported familiarity with international guidelines for ICD therapy. When asked to identify ICD indications 80% identified symptomatic or sustained ventricular arrhythmias and 73% left ventricular dysfunction. While 82% believed that the use of ICD therapy for secondary prevention was cost effective, only 53% believed they were cost effective for primary prevention. Lack of financial resource (88%), lack of local expertise (61%), lack of New Zealand guidelines (51%), and the referral process (43%) were seen as significant barriers to ICD referral by many participants. The majority of rural clinicians (71%) identified restricted access to investigations as a barrier to implantation, significantly higher than urban clinicians (18%, P = 0.001).

Conclusion: We have identified a number of potential barriers that will need to be addressed to raise the New Zealand ICD implantation rate.

Key Words: Implantable cardioverter defibrillators, Sudden cardiac death, Survey

* Corresponding author. Tel: +64 4 918 5103, Fax: +64 4 389 5318, Email: peter.larsen{at}otago.ac.nz

Manuscript submitted 7 May 2009. Accepted after revision 3 August 2009.


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