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Clinical and Hospital Factors Affecting Treatment with Primary Prevention Implantable Cardioverter-Defibrillators in Ischemic Cardiomyopathy Patients

 Jae Hyuk Lee  ;  Hee Tae Yu  ;  Il Young Oh  ;  Eue Keun Choi  ;  Jung Hoon Sung  ;  Young Soo Lee  ;  Jong Youn Kim  ;  Yongsoo Baek  ;  Junbeom Park  ;  Boyoung Joung 
 YONSEI MEDICAL JOURNAL, Vol.61(11) : 942-950, 2020-11 
Journal Title
Issue Date
Adult ; Aged, 80 and over ; Cardiomyopathies / epidemiology ; Cardiomyopathies / prevention & control* ; Cardiomyopathies / therapy ; Death, Sudden, Cardiac / etiology ; Death, Sudden, Cardiac / prevention & control* ; Defibrillators, Implantable / adverse effects* ; Defibrillators, Implantable / statistics & numerical data ; Electric Countershock / instrumentation* ; Female ; Heart Failure / diagnosis ; Heart Failure / physiopathology ; Heart Failure / therapy* ; Hospitals ; Humans ; Male ; Middle Aged ; Myocardial Ischemia / epidemiology ; Myocardial Ischemia / prevention & control* ; Myocardial Ischemia / therapy ; Primary Prevention / instrumentation* ; Primary Prevention / methods ; Prospective Studies ; Registries ; Republic of Korea / epidemiology ; Risk Factors ; Treatment Outcome
Defibrillators ; implantable ; myocardial ischemia ; primary prevention
Purpose: Implantable cardioverter defibrillators (ICD) are the standard of care for primary prevention (PP) in patients with ischemic cardiomyopathy (ICM). However, PP ICD implantation is underused in Asian countries. This study investigated ICD implantation rates and factors associated with appropriate PP ICD implants for ICM.

Materials and methods: In this prospective multicenter observational registry (ADVANCE-ICM registry), ICM patients who were eligible for PP ICD were screened and enrolled. Factors associated with appropriate ICD implantation, including hospital and clinical factors, were investigated.

Results: Of the 1453 ICM patients eligible for PP ICD [1111 male; median age, 71.0 (61.0-78.0) years], only 76 (5.2%) patients underwent ICD implantation. Among hospital factors, a non-monetary incentive for referral (72.4% vs. 52.9%, p=0.001) and total hospital system score (6.0 vs. 5.0, p=0.013) were higher in the ICD than in the no-ICD group. In multivariate analysis, total hospital system score [odds ratio (OR), 1.28; 95% confidence interval (CI), 1.10-1.50] was an independent factor for predicting ICD implantation, along with clinical factors, including high New York Heart Association class (≥III: OR, 7.29; 95% CI, 2.97-17.87) and younger age (<70 years: OR, 2.14; 95% CI, 1.30-3.53).

Conclusion: PP ICD implantation for ICM patients is underused in Korea. Hospital factors were important for improving PP ICD implantation rate, suggesting that new screening and referral systems for ICM patients would improve the PP ICD implantation rate (Clinical trial registration No. NCT03590925).
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Jae-Hyuk(이재혁) ORCID logo https://orcid.org/0000-0002-1170-7111
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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