title: Proportion of patients followed in a specialized heart failure clinic needing an implantable cardioverter defibrillator as determined by applying different trial eligibility criteria.
abstract: Numerous trials have demonstrated survival benefits using implantable cardioverter defibrillators (ICDs) for primary prevention in selected patients with left ventricular (LV) systolic dysfunction. However, eligibility criteria differed across these trials. Without a risk stratification scheme that clearly identifies those who will benefit, there remains debate about which patients with heart failure (HF) should receive ICDs for primary prevention. To explore the implications of applying different eligibility criteria, this study evaluated all patients seen in a specialized HF clinic from August 2003 to January 2004. Of the 309 consecutive patients in the cohort, 46 were excluded because their HF complicated recent myocardial infarcts (n = 3); their LV ejection fractions were not measured (n = 9); or their HF was due to valvular disease, myocarditis, or peripartum cardiomyopathy (n = 34). The Multicenter Automatic Defibrillator Implantation Trial-II criteria were met by 85 patients (32%), and 134 patients (51%) met the Sudden Cardiac Death in Heart Failure Trial criteria. Even allocation decisions based on randomized trial evidence can have vastly different resource implications depending on which trial is chosen. Thus, the development and validation of a risk stratification scheme to identify those patients most likely to benefit from ICDs for primary prophylaxis should be a research priority.
authors.affiliation: Division of General Internal Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Toma
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Justin
authors.initials: J
authors.lastname: Ezekowitz
authors.forename: Shane
authors.initials: S
authors.lastname: Kimber
authors.forename: Sajad
authors.initials: S
authors.lastname: Gulamhusein
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pantano
authors.forename: Soori
authors.initials: S
authors.lastname: Sivakumaran
authors.forename: Bibiana
authors.initials: B
authors.lastname: Cujec
authors.forename: Ian
authors.initials: I
authors.lastname: Paterson
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D003657:Decision Making; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011322:Primary Prevention / Q000295:instrumentation*; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000628:therapy*