TORONTO — The rate at which eligible, appropriate patients with a low left ventricular ejection fraction miss out on getting an implantable cardioverter defibrillator might be lower than most people think.
After ineligible patients and those who refused the device were accounted for, the “true miss” rate, or rate of patients with ejection fractions of 35% or less who failed to get an ICD was 7% in a random sample of 228 patients who underwent echocardiography scanning during 2005–2007 at Jefferson Medical College, Philadelphia.
However, the ICD implant rate in large, observational studies has usually been reported as about 25%–40% in patients with ejection fractions of 35% or less, Dr. Shaw Natan said while presenting a poster at the 14th World Congress on Heart Disease.
At Jefferson, the implant rate in the 228 patients who were the focus of this study was 42%, suggesting a miss rate of 68%. But assessing each patient individually showed that in most cases there was a good reason for the omission,” said Dr. Natan, a cardiologist formerly at Jefferson and now at St. Elizabeth's Medical Center in Boston, in an interview.
The 228 patients in the sample had an average age of 66 (range 29–96), and 68% were men. Their average LVEF was 21%.
Among the 132 patients in the sample who did not get an ICD, 89 (39% of the total) were ineligible: 34 had an inadequate trial of medical treatment or revascularization, 19 died, 17 had a life expectancy of less than 1 year or dementia, 10 were lost to follow-up, and 9 had other reasons.
Of the remaining 43 patients who were eligible for an ICD, 27 declined the device when it was offered. This left 16 patients (7% of the total number of patients evaluated) who were true misses for an ICD: They had no contraindications and were willing to receive treatment.