Referring patients for consideration of device treatment of sudden cardiac death and heart failure: incorporating evidence-based therapies within the Canadian health care system.
The growing use of the implantable cardioverter defibrillator (ICD) in Canada reflects the impact that primary and secondary prevention trials have had in demonstrating the superiority of the ICD over medical therapy in the prevention of sudden cardiac death in high-risk populations. Currently, there are significant regional disparities in ICD implantation in Canada. These disparities may reflect a lack of regional ICD implant and follow-up programs, and capping of funding for ICDs. In addition to increased funding for ICD systems, more resources are required to perform device implantations and follow patients over the long-term. Potentially eligible patients should be referred to an electrophysiologist for consideration of ICD therapy for the prevention of sudden cardiac death or to an electrophysiologist/ heart failure specialist for the consideration of combination cardiac resynchronization and ICD therapy for the management of refractory heart failure.
Gillis
Anne M
AM
Libin Cardiovascular Institute of Alberta, and Department of Cardiac Sciences, University of Calgary and Calgary Health Region, Alberta. amgillis@ucalgary.ca
D002170:Canada; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D012017:Referral and Consultation / Q000706:statistics & numerical data