title: Lack of current implantable cardioverter defibrillator guidelines application for primary prevention of sudden cardiac death in Latin American patients with heart failure: a cross-sectional study.
abstract: OBJECTIVE
  This cross-sectional study evaluated the application of accepted international implantable cardioverter defibrillator (ICD) guidelines for primary prevention of sudden cardiac death in patients with heart failure.
  
  
  RESULTS
  The PLASMA (Probabilidad de Sufrir Muerte Arritmica) study was designed to characterize management of cardiac patients in Latin America. Twelve centres included 1958 consecutively admitted patients in cardiology units in 2008 and 2009. Discharged patients were evaluated for primary prevention, ICD indication and prescription by general cardiologists. Of 1711 discharged patients, 1525 (89%) had data available for evaluating indication status. Class I indications for ICD therapy were met for 153 (10%) patients based on collected data. Only 20 (13%, 95% confidence interval: 7.7-18.4%) patients with indication were prescribed an ICD. Patients prescribed an ICD were younger than patients who were not prescribed an ICD (62 vs. 68 years, P < 0.01). The reasons given by cardiologists for not prescribing an ICD for 133 patients with an indication were: indication criteria not met (75%), life expectancy <1 year (9.7%), rejection by the patient (5.2%), no medical coverage paying for the device (3.7%), psychiatric patient (2.2%), and other reasons (4.2%).
  
  
  CONCLUSIONS
  In Latin America, international guidelines for primary prevention ICD implantation are not well followed. The main reason is that cardiologists believe that patients do not meet indication criteria, even though study data confirm that criteria are met. This poses a significant challenge and underlines the importance of continuous and improved medical education.
authors.affiliation: Sanatorio de la Trinidad San Isidro, Fondo de la Legua 851,  Buenos Aires, Argentina.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gonzalez-Zuelgaray
authors.forename: Oscar
authors.initials: O
authors.lastname: Pellizon
authors.forename: Claudio A
authors.initials: CA
authors.lastname: Muratore
authors.forename: Elsa Silva
authors.initials: ES
authors.lastname: Oropeza
authors.forename: Rafael
authors.initials: R
authors.lastname: Rabinovich
authors.forename: José Luis
authors.initials: JL
authors.lastname: Ramos
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Tentori
authors.forename: Nicolás
authors.initials: N
authors.lastname: Reyes
authors.forename: Rubén
authors.initials: R
authors.lastname: Aguayo
authors.forename: Jorge
authors.initials: J
authors.lastname: Marin
authors.forename: Brett J
authors.initials: BJ
authors.lastname: Peterson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000592:standards*; D002648:Child; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000401:mortality* / Q000628:therapy; D006801:Humans; D015994:Incidence; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D055815:Young Adult