| Referring Physicians' Discordance with the Primary Prevention Implantable Cardioverter-Defibrillator Guidelines: A National Survey. | |
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MedLine Citation:
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PMID: 22306794 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: The ACC/AHA/HRS Guidelines provide patient selection criteria for primary prevention implantable cardioverter-defibrillators (ICDs). For unknown reasons, guideline discordant practice is common. OBJECTIVE: To determine referring physicians' concordance with the primary prevention ICD guidelines. METHODS: We mailed a survey regarding ICD guidelines and individual practice characteristics to a random national sample of 3,000 physicians, 1/3 (rd) each specializing in family medicine, internal medicine, and general cardiology, selected from the American Medical Association Masterfile. RESULTS: Sixty-four percent with correct contact information responded. Three hundred and ninety-five (28%, 95% CI 25-30%) respondents never refer patients with the intent of consideration for a primary prevention ICD, including 7% (95% CI 5-10%) of cardiologists. Two hundred and twelve (15%, 95% CI 13-17%) believe ventricular arrhythmias are required before a primary prevention ICD is indicated; 525 (36%, 95% CI 34-39%) believe an ejection fraction > 40% warrants a primary prevention ICD; and 361 (25%, 95% CI 23-27%) would refer a patient for a primary prevention ICD within 40 days of a myocardial infarction. In multivariate analyses, family practice physicians and physicians residing in the Western US most often provided guideline-discordant answers, while cardiologists and those that refer to an electrophysiologist most often provided guideline-concordant answers. Primary care physicians that manage heart failure patients without referral to a subspecialist were not more likely to provide guideline concordant answers. CONCLUSIONS: Answers discordant with the primary prevention ICD guidelines were common, suggesting that referring physician beliefs are an important barrier to appropriate patient referrals for primary prevention ICD implantation. |
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Authors:
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Jorge M Castellanos; Lisa M Smith; Paul D Varosy; Christine Dehlendorf; Gregory M Marcus |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-2-2 |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: - ISSN: 1556-3871 ISO Abbreviation: - Publication Date: 2012 Feb |
Date Detail:
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Created Date: 2012-2-6 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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Copyright © 2012. Published by Elsevier Inc. |
Affiliation:
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Department of Medicine, University of California, San Francisco. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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