Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks

Silver, Marc T.; Sterns, Laurence D.; Piccini, Jonathan P.; Joung, Boyoung; Ching, Chi Keong; Pickett, Robert A.; Rabinovich, Rafael; Li, Shufeng; Peterson, Brett J.; Lexcen, Daniel R.

doi:10.1016/j.hrthm.2014.11.002

Cited by 11 publications

(4 citation statements)

References 21 publications

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“…reduction programming, but herein we show that this did not occur. 13 Publication of expert consensus documents is triggered by the availability of strong evidence coupled to a clinical need and marks an important milestone in practice. Evidence-practice gaps between such documents and medical management of patients with cardiovascular disease have been long recognized in sample patients drawn from clinics and even randomized trials.…”

Section: Discussionmentioning

confidence: 99%

“…One prior study of a much smaller and selected patient cohort (without using remote monitoring) noted that a prevalence of programming for delayed detection for ventricular fibrillation was only 19%. 13 Implementing a feedback mechanism, by delivering center-specific therapy programming reports detailing adherence to specified targets, and accompanying training, resulted in a 20% improvement. This included the patient group who had received implant before trial or consensus publications but were followed up after (ie, the group that appeared to be most vulnerable in our study).…”

Section: All Patientsmentioning

confidence: 99%

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How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Varma

Jones

Wold

et al. 2019

JAHA

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Background-Inappropriate implantable cardioverter-defibrillator programming can be detrimental. Whether trials/recommendations informing best implantable cardioverter-defibrillator programming (high-rate cutoff and/or extended duration of detection) influence practice is unknown. Methods and Results-We measured reaction to publication of MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy; 2012) and the Consensus Statement (2015) providing generic programming parameters, in a national cohort of implantable cardioverter-defibrillator recipients, using the ALTITUDE database (Boston Scientific). Yearly changes in programmed parameters to either trial-specified or class 1 recommended parameters (≥185 beats per minute or delay ≥6 seconds) were assessed in parallel. From 2008 to 2017, 232 982 patients (aged 67AE13 years; 28% women) were analyzed. Prevalence of MADIT-RIT-specific settings before publication was <1%, increasing to 13.6% in the year following. Thereafter, this increased by <6% over 5 years. Among preexisting implants (91 171), most patients (58 739 [64.4%]) underwent at least 1 inperson device reprogramming after trial publication, but <2% were reprogrammed to MADIT-RIT settings. Notably, prevalence of programming to ≥185 beats per minute or delay ≥6 seconds was increased by MADIT-RIT (57.4% in 2013 versus 40.2% at baseline), but the following publication of recommendations had minor incremental effect (73.2% in 2016 versus 70.8% in 2015). High-rate cutoff programming was favored almost 2-fold compared with extended duration throughout the test period. Practice changes demonstrated large interhospital and interstate variations. Conclusions-Trial publication had an immediate effect during 1 year postpublication, but absolute penetration was low, and amplified little with time. Consensus recommendations had a negligible effect. However, generic programming was exercised more widely, and increased after trial publication, but not following recommendations.

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Section: Discussionmentioning

confidence: 99%

Section: All Patientsmentioning

confidence: 99%

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Varma

Jones

Wold

et al. 2019

JAHA

View full text Add to dashboard Cite

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“…Patient‐level data were pooled from three large prospective ICD studies (Shock‐Less, 3 PainFree SST, 4 and PREPARE 5 ) and included those undergoing ICD implantation for primary prevention of sudden cardiac death. All patients provided written informed consent and the protocols of each study were fully compliant with the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient‐level meta‐analysis of three large clinical trials

Cheng

Joung

Brown

et al. 2020

Cardiovasc electrophysiol

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Background: Implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among cardiomyopathy patients. Whether or not antitachycardia pacing (ATP) is equally effective in ischemic (ICM) and nonischemic (NICM) cardiomyopathy patients remains poorly understood. We describe the distribution of monomorphic (MVT) and non-monomorphic (polymorphic ventricular tachycardia/ventricular fibrillation [PVT/VF]) ventricular tachyarrhythmias among ICM and NICM primary prevention patients. Methods: This patient-level meta-analysis included primary prevention patients from the Shock-Less (n = 3519), PainFree SST (n = 1917), and PREPARE (n = 690) studies. Distribution of MVT and PVT/VF events were compared with χ 2 tests. ATP success was estimated using a generalized estimating equation model to correct for multiple episodes for a patient between cohorts for slow (≥320 ms) and fast (240-310 ms) MVTs. Results: Among 6126 patients, 714 (29% NICM, age 66 ± 13 years, female 18%, EF = 29 ± 12%) had a total of 4444 treated ventricular tachyarrhythmia episodes. The rate of individuals treated for MVT or PVT/VF was comparable between ICM (11.9%) and NICM (11.2%) over 21 ± 10 months. In addition, the distribution of MVT (76% ICM vs. 71% NICM) and PVT/VF (15% ICM vs. 20% NICM) was not significantly different (p = .28). Among MVT episodes, the average tachycardia cycle lengths (332 ± 58 ms ICM vs. 313 ± 40 ms NICM; p = .27) were similar, as was the likelihood of ATP-associated termination (74.6% ICM vs. 76.4% NICM; p = .58). Overall, ATP success was higher for slow (≥320 ms) MVT versus faster (240-310 ms) episodes (84.1% vs. 69%; p < .001).

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“…In this month's issue of the Journal of Cardiovascular Electrophysiology , Cheng et al 3 sought to answer the specific questions of (1) whether the prevalence of MVT is similar in NICM compared to ICM patients and (2) whether ATP is just as effective for VA in NICM compared with ICM. In this meta‐analysis of the Shock‐Less, 4 PainFree SST, 5 and PREPARE 6 studies of a total of 6127 patients, the investigators found that patients with NICM experienced MVT and PMVT/VF at similar rates and proportions compared to patients with ICM. In addition, ATP was equally effective at terminating MVT in patients with NICM versus ICM (76% vs. 75%).…”

Section: Figurementioning

confidence: 99%

Antitachycardia pacing: A worthy cause?

Birgersdotter‐Green

2020

Cardiovasc electrophysiol

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Feedback to providers improves evidence-based implantable cardioverter-defibrillator programming and reduces shocks

Cited by 11 publications

References 21 publications

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

How Well Do Results From Randomized Clinical Trials and/or Recommendations for Implantable Cardioverter‐Defibrillator Programming Diffuse Into Clinical Practice?

Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient‐level meta‐analysis of three large clinical trials

Antitachycardia pacing: A worthy cause?

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