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Survey reveals discordance among physicians in following ICD guidelines
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More than one-quarter of physicians surveyed never refer patients with the intent of consideration for a primary prevention implantable cardioverter defibrillator, including 7% of cardiologists, according to survey results published in Heart Rhythm.
To determine physician concordance with primary prevention ICD guidelines from the American College of Cardiology, American Heart Association and Heart Rhythm Society, researchers mailed surveys to a random national sample of 3,000 physicians (one-third each specialized in general cardiology, internal medicine and family medicine).
Fifteen percent surveyed believe ventricular arrhythmias are required before a primary prevention ICD is indicated, 36% think an ejection fraction >40% warrants a primary prevention ICD and 25% would refer a patient for a primary prevention ICD within 40 days of a MI.
Multivariate analyses showed the most discordance among family practice physicians and physicians in the western United States. The most concordance to the guidelines was among cardiologists and those that refer to an electrophysiologist.
Gregory M. Marcus, MD, MAS, FHRS, of the University of California, San Francisco, told Cardiology Today that, of candidates who could be considered for ICD device implantation, a substantial proportion of them are not being considered. He believes primary care physicians should be familiarized with HF and device guidelines for arrhythmias if they are going to continue to care for patients with HF on their own.
“This study revealed that a substantial proportion of primary care physicians as well as a measureable amount of general cardiologists appear to be discordant with both the HF and device-based guidelines for arrhythmias, in regards to referring appropriate candidates for primary prevention ICDs. It is clear that a large number of primary care physicians, both internal medicine and family practice physicians, care for many of their patients with reduced LV systolic function without referring to a subspecialist,” he said. – by Casey Murphy
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Disclosure: Dr. Marcus has received research funding from St. Jude Medical and speakers fees from Medtronic and St. Jude Medical.
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