Sept. 7 (UPI) -- Canadian researchers found that, despite recommendations, implantable cardioverter defibrillators are being underutilized by doctors to save patients.
Sudden cardiac death as a result of cardiac arrest is estimated to be the number one cause of death worldwide by 2020. Fewer than 10 percent of patients who experience sudden cardiac arrest, or SCA, outside of a hospital survive, and recurrence rates after an initial event are high.
Because of the high risk of recurrence of an SCA, international and Canadian Cardiovascular Society guidelines strongly recommend the use of implantable cardioverter defibrillators, or ICDs, in certain patients who survive cardiac arrest.
However, a recent study, published Wednesday in the Canadian Journal of Cardiology, found that use of ICDs is low.
"This study illustrates that examining how medical care actually delivered in the 'real world' conforms to guidelines is vital in order to evaluate and improve care," Dr. Paul Dorian, director of the Division of Cardiology at the University of Toronto and staff cardiac electrophysiologist at St. Michael's Hospital, said in a press release.
"Our findings are the first step in the process to improve the quality of care provided to these patients, by assessing if the right patients receive the right treatment. The next step should be to understand 'why,' and to promote guideline-appropriate care."
Researchers anticipated finding rates of ICD use higher than 57 percent, but the overall ICD implementation rate was 23.9 percent.
Researchers analyzed medical records from 1,238 patients in the greater Toronto area who had survived an SCA out of the hospital setting. Patients who were categorized as likely ICD eligible if they would benefit from ICD implantation by having a shockable initial rhythm, no definite ischemia and a good neurologic status.
The study showed that of those patients deemed likely ICD eligible, 57 percent received an ICD, with the implantation rate of not likely ICD eligible at 16.7 percent.
A significant predictor of whether or not a patient received an ICD was the ICD implantation capacity of the hospital.
"There is insufficient information in this database to determine why this association exists, but some possible explanations include the absence of a local electrophysiology consultation service, perceived difficulty in access or transfer to implantation facilities, or differences in the specialty of the most responsible physician at the admission hospitals," Dorian said.