title: An unmet need for implantable cardioverter-defibrillators in New Zealand.
abstract: OBJECTIVE
  This study examined the prior history of all patients presenting to the regional ambulance service with community cardiac arrest to determine what proportion of these patients had prior indications for implanted cardioverter-defibrillator (ICD) therapy.
  
  
  RESULTS
  We reviewed the medical history of all adult patients presenting to our regional ambulance service with cardiac arrest between 1 June 2007 and 31 May 2008 (n= 144). Patients were classified as either not having an ICD indication, having a possible ICD indication, or having an ICD indication by two electrophysiologists. Eighty-seven patients (60%) had no pre-existing indication for an ICD. Twenty-two patients (15%) had a possible indication for an ICD but required further investigation to confirm this. This group consisted of 6 patients (4%) with previously documented left ventricular ejection fraction <35%, but without a measurement in the last 12 months, 14 patients (10%) with heart failure (n= 10) or syncope (n= 4) without appropriate investigations, and 2 patients with an ICD indication but with co-morbidities that required further investigation. Thirty-five patients (24%) had a documented indication for an ICD. In 11 (8%) there was no evidence of a contraindication, in 3 (2%) alternative therapy was judged more appropriate, and in 21 (15%) contraindications to ICD implantation were also present. Addition of the 11 patients with an ICD indication and the 6 patients with a documented indication requiring updated measurement, 17 patients (12%) had a prior documented ICD indication but had not been referred for this therapy.
  
  
  CONCLUSIONS
  Our observation that 12% of sudden cardiac arrest patients had prior indications for an ICD demonstrates that there is an unmet need for ICDs in New Zealand.
authors.affiliation: Cardiology Department Wellington Hospital, Wellington, New Zealand.
authors.forename: Sonya N
authors.initials: SN
authors.lastname: Burgess
authors.forename: Scott A
authors.initials: SA
authors.lastname: Harding
authors.forename: Iain C
authors.initials: IC
authors.lastname: Melton
authors.forename: Nigel A
authors.initials: NA
authors.lastname: Lever
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Swain
authors.forename: Bijia
authors.initials: B
authors.lastname: Shi
authors.forename: Peter D
authors.initials: PD
authors.lastname: Larsen
mesh_terms: D000368:Aged; D015897:Comorbidity; D000075202:Contraindications; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D013575:Syncope / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome