Is there unmet need for implantable cardioverter defibrillators? Findings from a post-mortem series of sudden cardiac death
Is there unmet need for implantable cardioverter defibrillators? Findings from a post-mortem series of sudden cardiac death
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DOI：
10.1093/europace/eun114
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发表时间：
2008-06-01
期刊：
影响因子：
6.1
通讯作者：
Morgan, John M.
中科院分区：
文献类型：
--
作者：
Chase, Deborah;Roderick, Paul J.;Morgan, John M.
目的是建立是否心脏性猝死（SCD）的受害者可以被确定之前，他们的事件，并考虑植入心脏复律除颤器（ICDs）。方法和结果连续死后的情况下，成人SCDs推测是由室性心律失常超过12个月（2002-03）从一个定义的集水区人口，南安普顿，英国（n = 443 824名年龄≥ 16岁的成年人）。病理学数据摘自尸检报告。医院和全科医生（GP）记录提供了有关既往症状、检查和心脏病史的数据。两名电生理学家根据国家指南判断每例ICD的适当性。215例病例符合入选标准，居住在集水区。专家之间关于ICD在80岁以下人群中的适用性的一致性良好（Kappa评分为0.64）。只有1例（< 1%）被认为适合植入ICD，无需进一步调查。49%的病例被认为需要进一步的心脏检查以确定适当性;这些主要是患有心肌梗死（MI）的心力衰竭患者。40%的病例以前没有确诊或疑似心脏病的临床证据。然而，病理数据显示，51%的情况下遭受了以前的MI。结论五分之二的SCD受害者没有记录的卫生服务接触，这将表明SCD的风险增加，在他们的一生。大量患者既往发生心脏事件或症状，提示SCD风险增加，但未转诊接受进一步检查。需要为MI后患者提供更好的护理途径，以确定需要ICD的患者。进行这些额外检查对ICD比率的影响尚不确定。
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 >= 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.