Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries: Clinical characteristics and reasons for implantation refusal

Balbir Singh, Shu Zhang, Chi Keong Ching, Dejia Huang, Yen Bin Liu, Diego A. Rodriguez, Azlan Hussin, Young Hoon Kim, Alexandr Robertovich Chasnoits, Jeffrey Cerkvenik, Katy A. Muckala, Alan Cheng

Research output: Contribution to journalArticle

Abstract

Background: Despite available evidence that implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among patients at risk for sudden cardiac death, utilization of ICDs is low especially in developing countries. Objective: To summarize reasons for ICD or cardiac resynchronization therapy defibrillator implant refusal by patients at risk for sudden cardiac arrest (Improve SCA) in developing countries. Methods: Primary prevention (PP) and secondary prevention (SP) patients from countries where ICD use is low were enrolled. PP patients with additional risk factors (syncope, ejection fraction < 25%, nonsustained ventricular tachycardia [NSVT], or frequent premature ventricular complexes) were further categorized as “1.5 PP patients.” Candidates who declined implantation were asked for reasons for refusal. Baseline factors that may have influenced the implant decision were examined using logistic regression. Results: Among 3892 patients, the implant refusal rate was 46.5% among PP patients (n = 2700), and 10.3% among SP patients (n = 1192). The most common refusal reason was inability to pay for the device (53.8%), followed by not believing in the benefits of the ICD (19.4%). Among PP ICD candidates, those with no syncope, no NSVT, no premature ventricular contractions, shorter QRS duration, no atrial arrhythmias, and no left bundle branch block were more likely to refuse implant. Among SP candidates, a history of cardiovascular surgery and no sinus node dysfunction were significant predictors of ICD refusal. Additionally, countries had significant differences in patient refusal rates among PP and SP groups. Conclusion: Implant refusal among PP patients is high in many countries. Increased reimbursement and better awareness of the benefits of an ICD could increase their utilization.

Original languageEnglish (US)
Pages (from-to)1619-1626
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume41
Issue number12
DOIs
StatePublished - Dec 1 2018
Externally publishedYes

Fingerprint

Implantable Defibrillators
Sudden Cardiac Death
Developing Countries
Primary Prevention
Secondary Prevention
Ventricular Premature Complexes
Syncope
Ventricular Tachycardia
Sick Sinus Syndrome
Cardiac Resynchronization Therapy
Defibrillators
Bundle-Branch Block
Cardiac Arrhythmias
Logistic Models
Equipment and Supplies
Mortality

Keywords

  • implantable cardioverter defibrillator
  • primary prevention
  • secondary prevention
  • sudden cardiac arrest
  • underutilization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries : Clinical characteristics and reasons for implantation refusal. / Singh, Balbir; Zhang, Shu; Ching, Chi Keong; Huang, Dejia; Liu, Yen Bin; Rodriguez, Diego A.; Hussin, Azlan; Kim, Young Hoon; Chasnoits, Alexandr Robertovich; Cerkvenik, Jeffrey; Muckala, Katy A.; Cheng, Alan.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 41, No. 12, 01.12.2018, p. 1619-1626.

Research output: Contribution to journalArticle

Singh, Balbir ; Zhang, Shu ; Ching, Chi Keong ; Huang, Dejia ; Liu, Yen Bin ; Rodriguez, Diego A. ; Hussin, Azlan ; Kim, Young Hoon ; Chasnoits, Alexandr Robertovich ; Cerkvenik, Jeffrey ; Muckala, Katy A. ; Cheng, Alan. / Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries : Clinical characteristics and reasons for implantation refusal. In: PACE - Pacing and Clinical Electrophysiology. 2018 ; Vol. 41, No. 12. pp. 1619-1626.
@article{351b5c0d09084a778377fb9eb66d8adf,
title = "Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries: Clinical characteristics and reasons for implantation refusal",
abstract = "Background: Despite available evidence that implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among patients at risk for sudden cardiac death, utilization of ICDs is low especially in developing countries. Objective: To summarize reasons for ICD or cardiac resynchronization therapy defibrillator implant refusal by patients at risk for sudden cardiac arrest (Improve SCA) in developing countries. Methods: Primary prevention (PP) and secondary prevention (SP) patients from countries where ICD use is low were enrolled. PP patients with additional risk factors (syncope, ejection fraction < 25{\%}, nonsustained ventricular tachycardia [NSVT], or frequent premature ventricular complexes) were further categorized as “1.5 PP patients.” Candidates who declined implantation were asked for reasons for refusal. Baseline factors that may have influenced the implant decision were examined using logistic regression. Results: Among 3892 patients, the implant refusal rate was 46.5{\%} among PP patients (n = 2700), and 10.3{\%} among SP patients (n = 1192). The most common refusal reason was inability to pay for the device (53.8{\%}), followed by not believing in the benefits of the ICD (19.4{\%}). Among PP ICD candidates, those with no syncope, no NSVT, no premature ventricular contractions, shorter QRS duration, no atrial arrhythmias, and no left bundle branch block were more likely to refuse implant. Among SP candidates, a history of cardiovascular surgery and no sinus node dysfunction were significant predictors of ICD refusal. Additionally, countries had significant differences in patient refusal rates among PP and SP groups. Conclusion: Implant refusal among PP patients is high in many countries. Increased reimbursement and better awareness of the benefits of an ICD could increase their utilization.",
keywords = "implantable cardioverter defibrillator, primary prevention, secondary prevention, sudden cardiac arrest, underutilization",
author = "Balbir Singh and Shu Zhang and Ching, {Chi Keong} and Dejia Huang and Liu, {Yen Bin} and Rodriguez, {Diego A.} and Azlan Hussin and Kim, {Young Hoon} and Chasnoits, {Alexandr Robertovich} and Jeffrey Cerkvenik and Muckala, {Katy A.} and Alan Cheng",
year = "2018",
month = "12",
day = "1",
doi = "10.1111/pace.13526",
language = "English (US)",
volume = "41",
pages = "1619--1626",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries

T2 - Clinical characteristics and reasons for implantation refusal

AU - Singh, Balbir

AU - Zhang, Shu

AU - Ching, Chi Keong

AU - Huang, Dejia

AU - Liu, Yen Bin

AU - Rodriguez, Diego A.

AU - Hussin, Azlan

AU - Kim, Young Hoon

AU - Chasnoits, Alexandr Robertovich

AU - Cerkvenik, Jeffrey

AU - Muckala, Katy A.

AU - Cheng, Alan

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: Despite available evidence that implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among patients at risk for sudden cardiac death, utilization of ICDs is low especially in developing countries. Objective: To summarize reasons for ICD or cardiac resynchronization therapy defibrillator implant refusal by patients at risk for sudden cardiac arrest (Improve SCA) in developing countries. Methods: Primary prevention (PP) and secondary prevention (SP) patients from countries where ICD use is low were enrolled. PP patients with additional risk factors (syncope, ejection fraction < 25%, nonsustained ventricular tachycardia [NSVT], or frequent premature ventricular complexes) were further categorized as “1.5 PP patients.” Candidates who declined implantation were asked for reasons for refusal. Baseline factors that may have influenced the implant decision were examined using logistic regression. Results: Among 3892 patients, the implant refusal rate was 46.5% among PP patients (n = 2700), and 10.3% among SP patients (n = 1192). The most common refusal reason was inability to pay for the device (53.8%), followed by not believing in the benefits of the ICD (19.4%). Among PP ICD candidates, those with no syncope, no NSVT, no premature ventricular contractions, shorter QRS duration, no atrial arrhythmias, and no left bundle branch block were more likely to refuse implant. Among SP candidates, a history of cardiovascular surgery and no sinus node dysfunction were significant predictors of ICD refusal. Additionally, countries had significant differences in patient refusal rates among PP and SP groups. Conclusion: Implant refusal among PP patients is high in many countries. Increased reimbursement and better awareness of the benefits of an ICD could increase their utilization.

AB - Background: Despite available evidence that implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among patients at risk for sudden cardiac death, utilization of ICDs is low especially in developing countries. Objective: To summarize reasons for ICD or cardiac resynchronization therapy defibrillator implant refusal by patients at risk for sudden cardiac arrest (Improve SCA) in developing countries. Methods: Primary prevention (PP) and secondary prevention (SP) patients from countries where ICD use is low were enrolled. PP patients with additional risk factors (syncope, ejection fraction < 25%, nonsustained ventricular tachycardia [NSVT], or frequent premature ventricular complexes) were further categorized as “1.5 PP patients.” Candidates who declined implantation were asked for reasons for refusal. Baseline factors that may have influenced the implant decision were examined using logistic regression. Results: Among 3892 patients, the implant refusal rate was 46.5% among PP patients (n = 2700), and 10.3% among SP patients (n = 1192). The most common refusal reason was inability to pay for the device (53.8%), followed by not believing in the benefits of the ICD (19.4%). Among PP ICD candidates, those with no syncope, no NSVT, no premature ventricular contractions, shorter QRS duration, no atrial arrhythmias, and no left bundle branch block were more likely to refuse implant. Among SP candidates, a history of cardiovascular surgery and no sinus node dysfunction were significant predictors of ICD refusal. Additionally, countries had significant differences in patient refusal rates among PP and SP groups. Conclusion: Implant refusal among PP patients is high in many countries. Increased reimbursement and better awareness of the benefits of an ICD could increase their utilization.

KW - implantable cardioverter defibrillator

KW - primary prevention

KW - secondary prevention

KW - sudden cardiac arrest

KW - underutilization

UR - http://www.scopus.com/inward/record.url?scp=85055591887&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85055591887&partnerID=8YFLogxK

U2 - 10.1111/pace.13526

DO - 10.1111/pace.13526

M3 - Article

C2 - 30320410

AN - SCOPUS:85055591887

VL - 41

SP - 1619

EP - 1626

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 12

ER -