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Is there unmet need for implantable cardioverter defibrillators? Findings from a post-mortem series of sudden cardiac death

Record type: Article

Aims: To establish whether sudden cardiac death (SCD) victims could have been identified prior to their event and considered for an implantable cardioverter defibrillators (ICDs).

Methods and results: Consecutive post-mortem cases of adult SCDs presumed to be caused by a ventricular arrhythmia over 12 months (2002-03) from a defined catchment population, Southampton, UK (n = 443 824 adults aged >or=16 years). Pathological data were extracted from the post-mortem reports. Hospital and general practice (GP) notes provided data on previous symptoms, investigations, and cardiac disease history. Two electrophysiologists judged the appropriateness of each case for an ICD against National Guidance. Two hundred and fifteen cases met the inclusion criteria and lived within the catchment area. Agreement between experts on appropriateness for an ICD in those aged <80 years was good (kappa score of 0.64). Only one case (<1%) was considered appropriate for an ICD without requirement for further investigation. Forty-nine per cent of cases were considered to have required further cardiac investigations to determine appropriateness; these were mainly heart failure patients who had suffered a myocardial infarction (MI). Forty per cent of cases had no previous clinical evidence of confirmed or suspected heart disease. However, pathological data showed that 51% of cases had suffered a previous MI.

Conclusion: Two-fifths of SCD victims had no recorded health service contact that would indicate increased risk of SCD within their lifetime. A large number of patients suffered previous cardiac events or symptoms suggestive of increased SCD risk but were not referred for further investigations. There is a need for better care pathways for patients post-MI to identify those requiring an ICD. The impact on the ICD rate of undertaking these extra investigations is uncertain.

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Citation

Chase, Deborah., Roderick, Paul J., Burnley, Hayley, Gallagher, Patrick J., Roberts, Paul R. and Morgan, John M. (2008) Is there unmet need for implantable cardioverter defibrillators? Findings from a post-mortem series of sudden cardiac death Europace, 10, (6), pp. 741-746. (doi:10.1093/europace/eun114). (PMID:18467301).

More information

e-pub ahead of print date: 7 May 2008
Published date: 2008
Keywords: sudden cardiac death, implantable cardioverter defibrillator, case studies, post-mortem
Organisations: Community Clinical Sciences, Infection Inflammation & Immunity

Identifiers

Local EPrints ID: 338787
URI: http://eprints.soton.ac.uk/id/eprint/338787
ISSN: 1099-5129
PURE UUID: 612171d2-bdfc-499f-b4d4-4198d1af3e9a
ORCID for Paul J. Roderick: ORCID iD orcid.org/0000-0001-9475-6850

Catalogue record

Date deposited: 17 May 2012 09:33
Last modified: 18 Jul 2017 05:57

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