ICD Implantation Rates in Cardiac Arrest Survivors in Canada

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2024-05-01 DOI:10.1016/j.cjco.2023.12.011
Farzad Darabi MD , Nigel S. Tan MD , Katherine S. Allan PhD , Steve Lin MD, MSc , Paul Angaran MD, MSc , Paul Dorian MD, MSc
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Abstract

Background

Patients resuscitated from out-of-hospital cardiac arrest (OHCA) are at high risk of recurrence, posing a substantial burden on healthcare systems. Despite the established benefit of implantable cardioverter defibrillator (ICD) therapy in many such patients, and recommendations by guidelines, few studies have described the proportion of OHCA patients who receive guideline-concordant care.

Methods

The Canadian Institute for Health Information Discharge Abstract Database dataset was used to identify OHCA patients admitted to hospitals across Canada, excluding Quebec. We analyzed all patients without a probable ischemic or bradycardia etiology of cardiac arrest, who survived to discharge, to estimate the ICD implantation rates in patients who were potentially eligible to have an ICD.

Results

Between 2013 and 2017, a total of 10,435 OHCA patients who were admitted to the hospital were captured in the database; 4486 (43%) survived to hospital discharge, and 2580 survivors (57.5%) were potentially eligible to receive an ICD. Among these potentially eligible patients, 757 (29.3%) received an ICD during their index admission or within 30 days after discharge from the hospital. The ICD implantation rate during index admission increased from 13.8% in 2013 to 19.6% in 2017 (P-value for time trend < 0.05). The rate of ICD implantations in potentially eligible patients was higher in urban than in rural settings (19.5% vs 11.1%) and in teaching vs community hospitals (34.7% vs 9.8%).

Conclusions

Although ICD implantation rates show an increasing trend among patients with OHCA who are likely eligible for secondary prevention, significant underutilization of ICDs persists in these patients.

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加拿大心脏骤停幸存者的 ICD 植入率
背景院外心脏骤停(OHCA)后复苏的患者复发的风险很高,给医疗系统带来了沉重的负担。尽管植入式心律转复除颤器(ICD)治疗对许多此类患者有明显的益处,而且指南也提出了建议,但很少有研究说明院外心脏骤停患者接受与指南一致的治疗的比例。结果2013年至2017年期间,数据库共记录了10435名入院的OHCA患者;4486人(43%)存活至出院,2580名存活者(57.5%)可能符合接受ICD治疗的条件。在这些可能符合条件的患者中,有 757 人(29.3%)在指标入院期间或出院后 30 天内接受了 ICD 治疗。索引入院期间的ICD植入率从2013年的13.8%增至2017年的19.6%(时间趋势的P值为< 0.05)。可能符合条件的患者的 ICD 植入率在城市高于农村(19.5% vs 11.1%),在教学医院高于社区医院(34.7% vs 9.8%)。结论虽然在可能符合二级预防条件的 OHCA 患者中,ICD 植入率呈上升趋势,但这些患者的 ICD 使用率仍然严重不足。
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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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