ArticleArquivos brasileiros de cardiologia2024
Potentially Inappropriate Cardioverter Defibrillator Implants in Secondary Prevention of Death.
Article in Arquivos brasileiros de cardiologia, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Broadening Insights into Implantable Cardioverter Defibrillator Appropriateness: The Role of Economic and Psychosocial Markers, Cardiomyopathy Subtypes, and Advanced TherapiesReply.Arquivos brasileiros de cardiologia · 2025Article
- Is it Fair to Contraindicate Cardiac Defibrillator Implantation for Patients with Socioeconomic or Psychological Vulnerability?Arquivos brasileiros de cardiologia · 2024Article
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5 authors.
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Abstract
backgroundImplantable cardioverter defibrillators (ICDs) are recommended for patients experiencing malignant tachyarrhythmias due to irreversible causes, who are clinically stable, and have a life expectancy exceeding one year. However, adverse socioeconomic and psychosocial conditions can adversely affect short-term survival and may render implantation inappropriate.
objectiveTo assess whether economic and psychosocial markers (EPSM) are associated with higher mortality in the first year (indicating potentially inappropriate implants) following ICD implantation.
methodsA prospective cohort study conducted between 2017 and 2021 included patients with heart failure and left ventricular ejection fraction (LVEF) < 50% who underwent ICD implantation for secondary prophylaxis. Prior to the procedure, patients were evaluated by an MDT, which examined four EPSM variables, namely socioeconomic vulnerability, self-care capacity, pharmacological adherence, and mood disorders. The participants were monitored for at least 12 months. Statistical significance was considered to be p-values < 0.05.
resultsA total of 208 individuals were included, with 144 (68.9%) being male. The mean LVEF was 32% ±9 and 107 (51%) had Chagas disease etiology. The mortality rate in the first year was 54/208 (25.8%). All patients who died had at least one of the EPSM and there no deaths were reported among the 73 (35.4%) who did not have EPSM. In multivariate analysis, having EPSM and LVEF were the only independent predictors of mortality under 1 year: RR 20.48 (2.75 - 52.29); p=0.003 and RR 0.97 (0.93 - 0.99); p=0.047, respectively.
conclusionSocioeconomic and psychosocial conditions should be identified and, where possible, resolved before implantation, as they may make device implantation a potentially inappropriate procedure.
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