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Europace Advance Access originally published online on June 20, 2009
Europace 2009 11(8):1048-1051; doi:10.1093/europace/eup145
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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

Varying implantable cardioverter defibrillator referral patterns from implanting and non-implanting hospitals

Paul A. Scott1,2,*, Nicholas G. Turner1,2, Aman Chungh1, John M. Morgan1,2 and Paul R. Roberts1,2

1 Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Tremona Road, Southampton SO16 6YD, UK; 2 University of Southampton, Southampton, UK

Aims: To assess the impact of hospital type on implantable cardioverter defibrillation (ICD) prescription rates.

Methods and results: The Wessex Cardiothoracic Unit is a regional implanting centre serving eight district general hospitals (DGHs). We audited all new ICD implants performed in our institution over 4 years. Hospitals implanting or referring patients elsewhere were excluded. We categorized patients into three different groups depending on local hospital type—regional centre (one hospital), DGH with a device specialist (one hospital), DGH without a device specialist (two hospitals). For each hospital type, we assessed the overall implant rate based on local population. There were 459 new ICD implants; of which 381 were included in the analysis. Implant rates were higher in areas whose local hospital was a regional centre (103/million/year), when compared with DGHs with (49/million/year) or without a device specialist (48/million/year). This disparity was greatest with respect to coronary artery disease primary prevention indications—implant rates 29, 14, and 9/million/year, respectively.

Conclusions: ICD implant rates are affected by hospital type and are significantly higher in regional centres when compared with DGHs. To increase ICD implant rates, the widespread implementation of clinical pathways to identify prospective primary prevention patients may be needed.

Key Words: Implantable cardioverter defibrillators, Sudden cardiac death

* Corresponding author. Tel: +44 02380 798487, Fax: +44 02380 796614, Email: paul.andrew.scott{at}btinternet.com

Manuscript submitted 24 February 2008. Accepted after revision 17 May 2009.


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