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Application of ICD guidelines and indications in a community-based academic hospital: a case series-based discussion

BACKGROUND: Implantable cardioverter defibrillators (ICDs) are indeed beneficial in selected patients as evidenced by multiple large randomized controlled trials (RCTs) since 1980. A systematic method for stratification of patients and hospital-wide criteria/guidelines to ascertain appropriate devic...

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Autores principales: Fan, WuQiang, Khalighi, Koroush
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Co-Action Publishing 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992359/
https://www.ncbi.nlm.nih.gov/pubmed/24765259
http://dx.doi.org/10.3402/jchimp.v4.23909
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author Fan, WuQiang
Khalighi, Koroush
author_facet Fan, WuQiang
Khalighi, Koroush
author_sort Fan, WuQiang
collection PubMed
description BACKGROUND: Implantable cardioverter defibrillators (ICDs) are indeed beneficial in selected patients as evidenced by multiple large randomized controlled trials (RCTs) since 1980. A systematic method for stratification of patients and hospital-wide criteria/guidelines to ascertain appropriate device implantation became necessary. METHODS: Major ICD/CRT (cardiac resynchronization therapy) clinical studies and relevant guidelines were reviewed, and an institution-wide inclusion and exclusion criteria for ICD/CRT was formulated. A retrospective analysis of selected cases was performed to discuss the criteria and special clinical situations. RESULTS: We have translated the evolving ICD/CRT studies into a standard of care at our hospital by formulating a standard, practical, and update-to-date ICD inclusion and exclusion criteria. Thirteen cases were selected to represent major indications and contraindications of ICDs in our practice. These cases cover indications of ICD for secondary prevention of sudden cardiac death (SCD), primary prevention of SCD in patients with CHF resulted from either ischemic or non-ischemic cardiomyopathy, as well as for infiltrative cardiomyopathy and inherited conditions. We discussed the application of CRT in patients with CHF associated with prolonged QRS duration. We then covered the potential benefits of ICD with/without CRT in certain special populations of patients that have not been adequately evaluated by currently available RCTs; these include alcoholic, elderly, female, and ESRD/HD patients. Finally, we addressed risks, complications and contraindications of ICD, as well as application of an external wearable defibrillator in AMI, or status post-CABG patient during the mandatory waiting period for an ICD. CONCLUSIONS: Establishment of the ICD/CRT criteria represents a practical translation of emerging CRTs and helps to standardize patient care in our hospital. It also improves cost-effectiveness as well as appropriate utilization of institute and device resources.
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spelling pubmed-39923592014-04-24 Application of ICD guidelines and indications in a community-based academic hospital: a case series-based discussion Fan, WuQiang Khalighi, Koroush J Community Hosp Intern Med Perspect Research Article BACKGROUND: Implantable cardioverter defibrillators (ICDs) are indeed beneficial in selected patients as evidenced by multiple large randomized controlled trials (RCTs) since 1980. A systematic method for stratification of patients and hospital-wide criteria/guidelines to ascertain appropriate device implantation became necessary. METHODS: Major ICD/CRT (cardiac resynchronization therapy) clinical studies and relevant guidelines were reviewed, and an institution-wide inclusion and exclusion criteria for ICD/CRT was formulated. A retrospective analysis of selected cases was performed to discuss the criteria and special clinical situations. RESULTS: We have translated the evolving ICD/CRT studies into a standard of care at our hospital by formulating a standard, practical, and update-to-date ICD inclusion and exclusion criteria. Thirteen cases were selected to represent major indications and contraindications of ICDs in our practice. These cases cover indications of ICD for secondary prevention of sudden cardiac death (SCD), primary prevention of SCD in patients with CHF resulted from either ischemic or non-ischemic cardiomyopathy, as well as for infiltrative cardiomyopathy and inherited conditions. We discussed the application of CRT in patients with CHF associated with prolonged QRS duration. We then covered the potential benefits of ICD with/without CRT in certain special populations of patients that have not been adequately evaluated by currently available RCTs; these include alcoholic, elderly, female, and ESRD/HD patients. Finally, we addressed risks, complications and contraindications of ICD, as well as application of an external wearable defibrillator in AMI, or status post-CABG patient during the mandatory waiting period for an ICD. CONCLUSIONS: Establishment of the ICD/CRT criteria represents a practical translation of emerging CRTs and helps to standardize patient care in our hospital. It also improves cost-effectiveness as well as appropriate utilization of institute and device resources. Co-Action Publishing 2014-04-14 /pmc/articles/PMC3992359/ /pubmed/24765259 http://dx.doi.org/10.3402/jchimp.v4.23909 Text en © 2014 WuQiang Fan and Koroush Khalighi http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Fan, WuQiang
Khalighi, Koroush
Application of ICD guidelines and indications in a community-based academic hospital: a case series-based discussion
title Application of ICD guidelines and indications in a community-based academic hospital: a case series-based discussion
title_full Application of ICD guidelines and indications in a community-based academic hospital: a case series-based discussion
title_fullStr Application of ICD guidelines and indications in a community-based academic hospital: a case series-based discussion
title_full_unstemmed Application of ICD guidelines and indications in a community-based academic hospital: a case series-based discussion
title_short Application of ICD guidelines and indications in a community-based academic hospital: a case series-based discussion
title_sort application of icd guidelines and indications in a community-based academic hospital: a case series-based discussion
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992359/
https://www.ncbi.nlm.nih.gov/pubmed/24765259
http://dx.doi.org/10.3402/jchimp.v4.23909
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