title: Use of a screening tool improves appropriate referral to an electrophysiologist for implantable cardioverter-defibrillators for primary prevention of sudden cardiac death.
abstract: BACKGROUND
  Despite data showing the benefits of implantable cardioverter-defibrillator (ICD) insertion for primary prevention in populations at risk for sudden death, professional society guidelines recommending primary prevention, and recognition by payers of the clinical value of ICDs in these populations, ICDs for primary prevention remain underused. We sought to determine whether implementing a screening tool would increase appropriate identification of patients showing clinical evidence of ICD benefit and prompt referral to an electrophysiologist for ICD implantation.
  
  
  RESULTS
  Screening tools were affixed to medical records for patients seen in 2 outpatient cardiology offices that queried ejection fraction and whether referral to an electrophysiologist was made (N=6632). The number of appropriate referrals in the screening period were compared with analogous data collected before implementation of the screening tool (control period) through retrospective record review (n=3606). Significantly more eligible patients were offered referral during the screening period than during the control period at both sites, 80% (8/10 eligible) versus 33% (5/15) at site 1 (P<0.02) and 100% (44/44) versus 60% (21/35) at site 2 (P<0.001). Of all patients offered referral, 41% (32/78) accepted.
  
  
  CONCLUSIONS
  The use of a screening tool increases referral to electrophysiology for patients in whom placement of an ICD confers the benefit of sudden cardiac death primary prevention. Barriers to referral include both physician and patient factors. Verification of these findings on a larger scale as well as studies defining the foundation of these barriers may further improve use of ICDs in patients for whom their mortality benefit is well described.
authors.affiliation: Brown University School of Medicine, Providence, RI, USA.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Gravelin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Yuhas
authors.forename: Michael
authors.initials: M
authors.lastname: Remetz
authors.forename: Martha
authors.initials: M
authors.lastname: Radford
authors.forename: John
authors.initials: J
authors.lastname: Foley
authors.forename: Rachel
authors.initials: R
authors.lastname: Lampert
mesh_terms: D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D015996:Survival Rate