Does Your Patient Need An Implanted Cardiac Defibrillator?

Purpose

The purpose of this Quality Improvement Project was to identify heart failure patients who met criteria for an Implanted Cardiac Defibrillator.

Background

Patients with heart failure are at risk of ventricular arrhythmias. Implantable cardiac defibrillators (ICDs) can significantly reduce sudden cardiac death. Unfortunately, ICD implantation is often underutilized. Based on studies, the American College of Cardiology and American Heart Association recommend ICDs in patients with depressed Ejection Fractions (EF) and heart failure. The Centers for Medicare & Medicaid Services have approved reimbursement for ICD placement in patients meeting criteria.

Methods

The Heart Failure Coordinators at Hackensack University Medical Center screened heart failure patients admitted to the hospital. Through real time screening and participation in Multidisciplinary Rounds (MDRs) we reviewed patients echocardiograms for ejection fractions (EF) of < _35%, New York Heart Association (NYHA) class I-III and ensured the patient had received optimal medical therapy for at least 3 months. Those with a terminal illness, life expectancy, cognitive or severe psychiatric illness were not included. If patients met criteria a recommendation was sent to the provider for a possible consultation to Electrophysiology (EP). Additionally, the Heart Failure Algorithm was modified to suggest EP consults for patients with EF< 35%.

Results

Improvements in our compliance to the Get With The Guidelines- Heart Failure (GWTG-HF) Quality Measure AHAHF12: ICD Counseling or ICD Placed or Prescribed at Discharge increased by 20% from Quarter 1 203 to Quarter 2 2023 and additionally increased by 7% in Quarter 3. Through daily screening and the use of the Heart Failure Algorithm, cases were identified and presented at our monthly Heart Failure Adjudication meetings. These presentations not only assisted in referrals to EP, but also captured our audience. The presentations increased the awareness of our medical centers providers.

Conclusion

The use of daily screening increased referrals to Electrophysiology and identification of patients that met criteria for for device therapy. Consideration of ICD implantation must be a shared decision making process. As the population for heart failure continues to grow, device therapy can improve overall survival. It is vital to remain aware of technologies and devices that can refine management of complexed heart failure care.