Barriers to implementation of evidence-based electrical therapies and the need for outcome research: role of European registries

Abstract

Although clinical trial results and the implementation of current guidelines appear to have encouraged progress in the treatment of arrhythmias, great discrepancies still exist between European Society of Cardiology (ESC) member countries. Guidelines are not adhered to for a variety of reasons. This cannot be explained only by economic factors, although these obviously play a substantial role. Other factors responsible for adequate guideline implementation appear to be the lack of trained personnel, the lack of infrastructure, or different health insurance systems. In this complex scenario, the data based on European registries are useful for creating standards and harmonizing the treatment of arrhythmias. Moreover, a summary of registry data, such as presented in the European Heart Rhythm Association (EHRA) White Book, can provide the opportunity to share and exchange information among ESC member countries on specific needs for improvements, reimbursement policy, and training issues.

Frequency and Determinants of Implantable Cardioverter Defibrillator Deployment Among Primary Prevention Candidates With Subsequent Sudden Cardiac Arrest in the Community

“…Recent reports have suggested that ICDs may be significantly underused in the community for both primary and secondary prevention. [13][14][15] However, the extent of deployment of the primary ICD among eligible subjects who eventually experience a cardiac arrest in the general population has not been studied previously. We therefore sought to evaluate the frequency and potential determinants of nondeployment of the primary ICD among subjects who experienced SCA in the community.…”

Use of Primary Prevention Implantable Cardioverter-Defibrillators in a Population-Based Cohort Is Associated With a Significant Survival Benefit

“…32 There are many reasons to account for this: system factors, physician factors, and patient factors. System factors include such things as lack of access to appropriate investigations such as echocardiography, decreased access to specialist care in rural areas, delay between published guidelines and adoption into clinical practice, inadequate knowledge translation of the guidelines.…”

Haciendo medicina “con el diario del lunes”

“…En el documento referido al uso apropiado de los DAI y la resincronización cardíaca de 2013 (26) se incluyen muchas de las situaciones no específicamente incluidas en las guías y se establece un puntaje de 1 a 9, siendo apropiado el uso del DAI en las situaciones con puntuación 7 o mayor. Las indicaciones de prevención primaria de muerte súbita tienen todas una puntuación mayor a 7.…”