TY - JOUR
T1 - Improve the Prevention of Sudden Cardiac Arrest in Patients With Post-Acute Myocardial Infarction
AU - Improve Sudden Cardiac Arrest Bridge Investigators
AU - Zhang, Shu
AU - Chen, Wen Jone
AU - Sankardas, Mullasari Ajit
AU - Ahmed, Waqar Habib
AU - Liew, Houng Bang
AU - Gwon, Hyeon Cheol
AU - Nesa Malik, Fazila Tunn
AU - Tang, Baopeng
AU - Haggui, Abdeddayem
AU - Oh, Il Young
AU - Ong, Tiong Kiam
AU - Cheng, Cheng I.
AU - Liu, Xingbin
AU - Seth, Ashok
AU - Choi, Young Jin
AU - Qamar, Nadeem
AU - Rungpradubvong, Voravut
AU - Wang, Chun Chieh
AU - Jeon, Jin Kyung
AU - Wong, Grace
AU - Lemme, Francesca
AU - Van Dorn, Brian
AU - Lexcen, Dan
AU - Huang, Dejia
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/10
Y1 - 2022/10
N2 - Background: Implantable cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients varies by geography but remains low in many regions despite guideline recommendations. Objectives: This study aimed to characterize the care pathway of post-MI patients and understand barriers to referral for further SCD risk stratification and management in patients meeting referral criteria. Methods: This prospective, nonrandomized, multi-nation study included patients ≥18 years of age, with an acute MI ≤30 days and left ventricular ejection fraction <50% ≤14 days post-MI. The primary endpoint was defined as the physician's decision to refer a patient for SCD stratification and management. Results: In total, 1,491 post-MI patients were enrolled (60.2 ± 12.0 years of age, 82.4% male). During the study, 26.7% (n = 398) of patients met criteria for further SCD risk stratification; however, only 59.3% of those meeting criteria (n = 236; 95% CI: 54.4%-64.0%) were referred for a visit. Of patients referred for SCD risk stratification and management, 94.9% (n = 224) attended the visit of which 56.7% (n =127; 95% CI: 50.1%-63.0%) met ICD indication criteria. Of patients who met ICD indication criteria, 14.2% (n = 18) were implanted. Conclusions: We found that ∼40% of patients meeting criteria were not referred for further SCD risk stratification and management and ∼85% of patients who met ICD indications did not receive a guideline-directed ICD. Physician and patient reasons for refusing referral to SCD risk stratification and management or ICD implant varied by geography suggesting that improvement will require both physician- and patient-focused approaches.
AB - Background: Implantable cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients varies by geography but remains low in many regions despite guideline recommendations. Objectives: This study aimed to characterize the care pathway of post-MI patients and understand barriers to referral for further SCD risk stratification and management in patients meeting referral criteria. Methods: This prospective, nonrandomized, multi-nation study included patients ≥18 years of age, with an acute MI ≤30 days and left ventricular ejection fraction <50% ≤14 days post-MI. The primary endpoint was defined as the physician's decision to refer a patient for SCD stratification and management. Results: In total, 1,491 post-MI patients were enrolled (60.2 ± 12.0 years of age, 82.4% male). During the study, 26.7% (n = 398) of patients met criteria for further SCD risk stratification; however, only 59.3% of those meeting criteria (n = 236; 95% CI: 54.4%-64.0%) were referred for a visit. Of patients referred for SCD risk stratification and management, 94.9% (n = 224) attended the visit of which 56.7% (n =127; 95% CI: 50.1%-63.0%) met ICD indication criteria. Of patients who met ICD indication criteria, 14.2% (n = 18) were implanted. Conclusions: We found that ∼40% of patients meeting criteria were not referred for further SCD risk stratification and management and ∼85% of patients who met ICD indications did not receive a guideline-directed ICD. Physician and patient reasons for refusing referral to SCD risk stratification and management or ICD implant varied by geography suggesting that improvement will require both physician- and patient-focused approaches.
KW - cardiac resynchronization therapy–defibrillator
KW - delivery of health care
KW - implantable cardioverter-defibrillator
KW - myocardial infarction
UR - http://www.scopus.com/inward/record.url?scp=85139447594&partnerID=8YFLogxK
U2 - 10.1016/j.jacasi.2022.06.006
DO - 10.1016/j.jacasi.2022.06.006
M3 - Article
AN - SCOPUS:85139447594
VL - 2
SP - 559
EP - 571
JO - JACC: Asia
JF - JACC: Asia
SN - 2772-3747
IS - 5
ER -