title: Need and evolution of need for device therapy in a community heart failure population.
abstract: BACKGROUND
  New guidelines for implantable cardiac defibrillators (ICD) and cardiac resynchronisation therapy (CRT) have expanded the potential use for device therapy. The implications of this on a community heart failure (HF) population are unknown.
  
  
  OBJECTIVE
  To assess the need for device therapy and the change in need over time.
  
  
  METHODS
  We reviewed device need in a community HF population using ESC guidelines. Change in need was assessed by comparing data between an annual visit called TP2 and an earlier visit called TP1. Patients' need and change in need between TP1 and TP2 was determined.
  
  
  RESULTS
  210 patients were included; mean age 70+/-12 years, 67% male and 54% ischaemic. At TP1, 34% of patients were suitable for ICD and 3% for CRT. At TP2, 22% and 1% were suitable respectively. Of those suitable for ICD at TP1, 19% lost the need at TP2; in addition 9% of patients unsuitable for ICD at TP1 had acquired the need by TP2. Fifty five percent of patients were unsuitable for ICD at either time point, and 16% were suitable at both time points. CRT need was negligible but also noted to change.
  
  
  CONCLUSIONS
  ICD need is substantial in a community HF population, but CRT need is limited. ICD need changes significantly. Identifying those likely to change their need may optimise ICD use.
authors.affiliation: Heart Failure Unit, Department of Cardiology, St Vincent's University Hospital, Dublin 4, Ireland.
authors.forename: Habitha M
authors.initials: HM
authors.lastname: Sulaiman
authors.forename: Christina
authors.initials: C
authors.lastname: O'Loughlin
authors.forename: Marie
authors.initials: M
authors.lastname: Daly
authors.forename: Carmel
authors.initials: C
authors.lastname: Conlon
authors.forename: Mark
authors.initials: M
authors.lastname: Ledwidge
authors.forename: Dermot
authors.initials: D
authors.lastname: McCaffrey
authors.forename: Kenneth
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003153:Community Health Services; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013318:Stroke Volume