title: Primary prevention of defibrillator implantation after myocardial infarction: clinical practice and compliance to guidelines.
abstract: OBJECTIVE
  The purpose of this study is to investigate compliance to established guidelines regarding primary prevention with implantable cardioverter-defibrillator (ICD) in patients with left ventricular dysfunction after acute myocardial infarction (AMI) in a clinical setting.
  
  
  RESULTS
  A retrospective study of medical records from patients admitted to two hospitals in Stockholm during 2008-2009 with a diagnosis of AMI and who at discharge had a left ventricular ejection fraction ≤35%. An evaluation of follow-up and echocardiographic recordings was performed 1-3 months after AMI. A total of 2023 patients <80 years, with AMI discharged from hospital, were screened for left ventricular dysfunction defined as ejection fraction (EF) ≤35%. Altogether 187 patients were identified and an ICD was implanted in 25 (13%) patients. In 52 (28%) patients, there were contraindications for ICD therapy. An improved EF at follow-up, making ICD treatment redundant, was observed in 48 (41%) patients who underwent an ECHO at follow-up or later. Seventeen (9%) patients without an ICD died during follow-up and out of these five patients died from sudden cardiac death (SCD), they had no contraindication to ICD therapy. An inadequate follow-up according to guidelines was found in 59 (32%) patients.
  
  
  CONCLUSIONS
  The follow-up of post-myocardial infarction patients with left ventricular dysfunction according to guidelines was insufficient in this population and may have increased the risk for SCD. A significant proportion of patients experienced improved left ventricular function during short-term follow-up making preventive ICD treatment redundant.
authors: Department of Clinical Sciences, Karolinska Institutet, Danderyds Sjukhus AB, Stockholm, Sweden. Johanna.sjoblom@ds.se
authors: Johanna
authors: J
authors: Sjöblom
authors: Lina
authors: L
authors: Ljung
authors: Mats
authors: M
authors: Frick
authors: Mårten
authors: M
authors: Rosenqvist
authors: Viveka
authors: V
authors: Frykman
mesh_terms: D000368:Aged; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000517:prevention & control*