https://scholars.lib.ntu.edu.tw/handle/123456789/536379
標題: | Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries: Clinical characteristics and reasons for implantation refusal | 作者: | Singh B. Zhang S. Ching C.-K. Huang D. YEN BIN LIU Rodriguez D.A. Hussin A. Kim Y.-H. Chasnoits A.R. Cerkvenik J. Muckala K.A. Cheng A. |
關鍵字: | implantable cardioverter defibrillator; primary prevention; secondary prevention; sudden cardiac arrest; underutilization | 公開日期: | 2018 | 出版社: | Blackwell Publishing Inc. | 卷: | 41 | 期: | 12 | 起(迄)頁: | 1619-1626 | 來源出版物: | PACE - Pacing and Clinical Electrophysiology | 摘要: | Background: Despite available evidence that implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among patients at risk for sudden cardiac death, utilization of ICDs is low especially in developing countries. Objective: To summarize reasons for ICD or cardiac resynchronization therapy defibrillator implant refusal by patients at risk for sudden cardiac arrest (Improve SCA) in developing countries. Methods: Primary prevention (PP) and secondary prevention (SP) patients from countries where ICD use is low were enrolled. PP patients with additional risk factors (syncope, ejection fraction?25%, nonsustained ventricular tachycardia [NSVT], or frequent premature ventricular complexes) were further categorized as “1.5 PP patients.” Candidates who declined implantation were asked for reasons for refusal. Baseline factors that may have influenced the implant decision were examined using logistic regression. Results: Among 3892 patients, the implant refusal rate was 46.5% among PP patients (n = 2700), and 10.3% among SP patients (n = 1192). The most common refusal reason was inability to pay for the device (53.8%), followed by not believing in the benefits of the ICD (19.4%). Among PP ICD candidates, those with no syncope, no NSVT, no premature ventricular contractions, shorter QRS duration, no atrial arrhythmias, and no left bundle branch block were more likely to refuse implant. Among SP candidates, a history of cardiovascular surgery and no sinus node dysfunction were significant predictors of ICD refusal. Additionally, countries had significant differences in patient refusal rates among PP and SP groups. Conclusion: Implant refusal among PP patients is high in many countries. Increased reimbursement and better awareness of the benefits of an ICD could increase their utilization. ? 2018 Wiley Periodicals, Inc. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85055591887&doi=10.1111%2fpace.13526&partnerID=40&md5=c136fb84fb25baea84ac50c1028a9472 https://scholars.lib.ntu.edu.tw/handle/123456789/536379 |
ISSN: | 0147-8389 | DOI: | 10.1111/pace.13526 | SDG/關鍵字: | adult; aged; Article; cardiac resynchronization therapy; cardiovascular risk; cardiovascular surgery; clinical feature; controlled study; developing country; faintness; female; health care utilization; heart atrium arrhythmia; heart ejection fraction; heart left bundle branch block; heart ventricle extrasystole; heart ventricle tachycardia; high risk patient; human; logistic regression analysis; major clinical study; male; medical history; multicenter study; nonsustained ventricular tachycardia; primary prevention; prospective study; QRS interval; secondary prevention; sinus node disease; sudden cardiac death; treatment refusal; very elderly |
顯示於: | 醫學系 |
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