title: Effect of a Reminder Statement on Echocardiography Reports on Referrals for Implantable Cardioverter-Defibrillators for Primary Prevention.
abstract: Numerous trials show the benefit of implantable cardioverter-defibrillators (ICDs) for primary prevention in patients with low ejection fraction (EF), a class I indication. However, underutilization is well documented. We retrospectively reviewed charts to see whether placing a reminder statement into echocardiogram reports for appropriate patients increased adherence to guidelines. From January through June 2013, a brief reminder of the ICD guidelines was automatically inserted into echocardiogram reports with EF ≤ 35% (reminder period). Charts were reviewed to determine if these patients (1) were referred to Electrophysiology (EP) within 6 months of the index echo and (2) received an ICD within 6 months of EP referral. Chart review of all patients who had an echocardiogram performed between March and August 2012 with an EF ≤ 35% provided a control period. More patients were referred to EP in the reminder period compared with control period, 68% (54 of 80) versus 51% (53 of 104), p = 0.03. There was also a higher rate of discussions in the reminder period between patients and physicians about ICD therapy (71% vs 54%, p = 0.02). Among patients appropriate for ICD, 52% of patients during the reminder period received an ICD versus 38% of patients during the control period (p = 0.11). A simple reminder statement on echocardiography reports led to a significant improvement in appropriate EP referrals and a trend toward increased ICD implantation in appropriate patients.
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Moulin
authors.initials: M
authors.lastname: Chokshi
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Robert L
authors.initials: RL
authors.lastname: McNamara
authors.affiliation: Lehigh Valley Hospital, Allentown, Pennsylvania.
authors.forename: Yasotha
authors.initials: Y
authors.lastname: Rajeswaran
authors.affiliation: Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut. Electronic address: rachel.lampert@yale.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lampert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004282:Documentation / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D017010:Reminder Systems; D012189:Retrospective Studies; D018570:Risk Assessment; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000628:therapy*