© 2008 European Society of Cardiology
Need and evolution of need for device therapy in a community heart failure population
Heart Failure Unit, Department of Cardiology, St Vincent's University Hospital, University College Dublin Dublin 4, Ireland Heartbeat Trust 3, Crofton Terrace, Dun Laoghaire, Co Dublin, Ireland
* Corresponding author. Department of Cardiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Tel.: +353 1 2304629; fax: +353 1 2304639. E-mail address: kenneth.mcdonald{at}ucd.ie
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Abstract |
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Background: New guidelines for implantable cardiac defibrillators (ICD) and cardiac resynchronisation therapy (CRT) have expanded the potential use for device therapy. The implications of this on a community heart failure (HF) population are unknown.
Aim: To assess the need for device therapy and the change in need over time.
Methods: We reviewed device need in a community HF population using ESC guidelines. Change in need was assessed by comparing data between an annual visit called TP2 and an earlier visit called TP1. Patients'need and change in need between TP1 and TP2 was determined.
Results: 210 patients were included; mean age 70±12 years, 67% male and 54% ischaemic. At TP1, 34% of patients were suitable for ICD and 3% for CRT. At TP2, 22% and 1% were suitable respectively. Of those suitable for ICD at TP1, 19% lost the need at TP2; in addition 9% of patients unsuitable for ICD at TP1 had acquired the need by TP2. Fifty five percent of patients were unsuitable for ICD at either time point, and 16% were suitable at both time points. CRT need was negligible but also noted to change.
Conclusion: ICD need is substantial in a community HF population, but CRT need is limited. ICD need changes significantly. Identifying those likely to change their need may optimise ICD use.
Key Words: Device therapy • Implantable cardiac defibrillator • Cardiac resynchronisation therapy • Heart failure • Disease management programme • Left ventricular ejection fraction
Received November 15, 2007; Revised March 11, 2008; Accepted April 21, 2008
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