SUBANALISIS V CONAREC XVIII

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Implantable cardioverter-defibrillator guidelines application in Argentine patients with heart failure. A registry from 64 cardiology residencies

A.G. Carrizo, E. Fairmanl, N. Gonzalez, L. Corradi, E. Zaidel, G. Perez, A. Alfiel, O. Oseroffl,  CONAREC.

Topic(s)

Primary prevention (Sudden cardiac death and implantable defibrillators)

Citation

Europace ( 2013 ) 15 ( S2 ), S146

Guidelines

(GL) establish as Class I indication for primary prevention (pp) Implantable Cardioverter Defibrillator (ICD) in symptomatic patients (p) with left ventricular ejection fraction (LVEF) ≤35% or asymptomatic with LVEF <30% due to myocardial infarction (MI). The purpose of present study was to evaluate the real daily application of GL for pp in p with heart failure (HF) and factors related for the implant.

Methods

The CONAREC XVIII registry included 1310 consecutively HF p during ]une and July 2011 in Argentina from 64 centers with Cardiology Residency. Audit excluded 33 p. We looked for p with Class I ICD indication and comparad those who got the ICD (Y-ICD) versus (vs) those who did not get the ICD (N-ICD). We used the MADIT-II Risk Score (ICD benefit using five factors), those with ≥3 factors do not benefit from ICD therapy.

Results

Of 1277 p enrolled, 263 p (20.6%) had Class I indication and only 39 p (14.8%) with indication were prescribed an ICD. Y-ICD subgroup, compared with N-ICD subgroup, had a significant higher incidence of MI, syncope and CRT, lower LVEF (mean 23 vs 27 p=<0.001) and wider QRS (mean 0.14s vs 0.12s p=<0.01). We observed a higher prescription in p treated at private centers (19% vs 8% p=0.01) located in Buenos Aires City (20% vs 10% p=0.04) and those with ≥8 cardiology residents (20% vs 7% p=<0.01). Table 1 shows distribution of population according to Risk Score and the independent predictors of ICD implant.

Conclusion

The ICD rate prescription for primary prevention in Argentina is low according to GL and an important proportion of patients who received ICD belong to the group with less benefit. GL indications are better followed by centers with more residents.

 

 

Y-ICD (n 39)

N-ICD (n 224)

P

Multivariate Analysis OR (95%IC)

Low/Intermediate Risk (0-2 RF)

66.7

76

Ns

 

High Risk

(≥3 RF)

33.3

24

Ns

 

LVEF

23

 (20 – 26)

27

(25 – 30)

<0.001

1.6

 (1.3 – 1.9)

QRS >0.12s

64.1

31.3

<0.001

7.9

 (1.1 – 20.7)

CRT

79

21

<0.001

109

 (14.8 – 815)

≥8 Residents

79.5

54.5

<0.01

4.8

 (1.1 – 20.7)

 

Values are % or median (intercuartile range) Risk factors(RF): CF >11, age >70 years, blood urea nitrogen >26mg/dl, atrial fibrillation an1 QRS >0.12s.

 

 

EUROPACE – EHRA 2013

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