Many US ICD implants not evidence based

For patients with severe systolic heart failure, several randomised trials have shown the ability of implantable cardioverter-defibrillator (ICD) devices to prevent sudden cardiac death.  However, current US guidelines recommend against ICD insertion within 3 months of an initial heart-failure diagnosis, or within forty days of a myocardial infarction.

This retrospective cohort study of cases submitted to the National Cardiovascular Data Registry-ICD Registry between January 1, 2006, and June 30, 2009 looked at data from 111 707 patients.  25145 (22.5%) of patients received non-evidence-based ICD implants.  Patients who received a non-evidence-based ICD had a higher risk of in-hospital death (0.57% vs 0.18%, P<0.001) and any post-procedural complication (3.23% vs 2.41%, P<0.001) than patients who received an ICD appropriately.  Electrophysiologists were less likely to implant an ICD inappropriately than other cardiologists or thoracic surgeons.

Conclusions

Almost a quarter of ICD implants performed in the USA are inappropriate according to current guidelines; in most cases this was due to inappropriate timing of insertion.

  • Khatib SM, Hellkamp A, Curtis J, et al. Non-evidence-based ICD implantations in the United States. JAMA 2011; 305:43-49.
  • Kadish A and Goldberger J. Selecting patients for ICD implantation: Are clinicians choosing appropriately? JAMA 2011; 305:91-92.