TY - JOUR
T1 - Wearable cardioverter-defibrillator use in patients perceived to be at high risk early post-myocardial infarction
AU - Epstein, Andrew E.
AU - Abraham, William T.
AU - Bianco, Nicole R.
AU - Kern, Karl B.
AU - Mirro, Michael
AU - Rao, Sunil V.
AU - Rhee, Edward K.
AU - Solomon, Scott D.
AU - Szymkiewicz, Steven J.
N1 - Funding Information:
Dr. Epstein has received honoraria and research support from Biotronik , Boston Scientific , Medtronic , and St. Jude Medical ; has been a consultant for ZOLL Medical; received research grants from Biotronik , Boston Scientific , Medtronic , and St. Jude Medical ; and received fellowship support from Boston Scientific , Medtronic , and St. Jude Medical . Dr. Abraham has been a consultant for Biotronik, Medtronic, and St. Jude Medical. Drs. Bianco and Szymkiewicz are employees of ZOLL. Dr. Kern has been a consultant for PhysioControl and ZOLL; and has been on the Science Advisory Board of ZOLL Medical. Dr. Mirro has been a consultant for ZOLL, McKesson, St. Jude Medical, and iRhythm. Dr. Rao has been a consultant for and received honoraria from ZOLL. Dr. Rhee has been a consultant for and has received honoraria from ZOLL.
PY - 2013/11/19
Y1 - 2013/11/19
N2 - Objectives The aim of this study was to describe usage of the wearable cardioverter-defibrillator (WCD) during mandated waiting periods following myocardial infarction (MI) for patients perceived to be at high risk for sudden cardiac arrest (SCA). Background Current device guidelines and insurance coverage require waiting periods of either 40 days or 3 months before implanting a cardioverter-defibrillator post-myocardial infarction (MI), depending on whether or not acute revascularization was undertaken. Methods We assessed characteristics of and outcomes for patients who had a WCD prescribed in the first 3 months post-MI. The WCD medical order registry was searched for patients who were coded as having had a "recent MI with ejection fraction ≤35%" or given an International Classification of Diseases, Ninth Revision 410.xx diagnostic code (acute MI), and then matched to device-recorded data. Results Between September 2005 and July 2011, 8,453 unique patients (age 62.7 ± 12.7 years, 73% male) matched study criteria. A total of 133 patients (1.6%) received 309 appropriate shocks. Of these patients, 91% were resuscitated from a ventricular arrhythmia. For shocked patients, the left ventricular ejection fraction (LVEF) was ≤30% in 106, 30% to 35% in 17, >36% in 8, and not reported in 2 patients. Of the 38% of patients not revascularized, 84% had a LVEF ≤30%; of the 62% of patients revascularized, 77% had a LVEF ≤30%. The median time from the index MI to WCD therapy was 16 days. Of the treated patients, 75% received treatment in the first month, and 96% within the first 3 months of use. Shock success resulting in survival was 84% in nonrevascularized and 95% in revascularized patients. Conclusions During the 40-day and 3-month waiting periods in patients post-MI, the WCD successfully treated SCA in 1.4%, and the risk was highest in the first month of WCD use. The WCD may benefit individual patients selected for high risk of SCA early post-MI.
AB - Objectives The aim of this study was to describe usage of the wearable cardioverter-defibrillator (WCD) during mandated waiting periods following myocardial infarction (MI) for patients perceived to be at high risk for sudden cardiac arrest (SCA). Background Current device guidelines and insurance coverage require waiting periods of either 40 days or 3 months before implanting a cardioverter-defibrillator post-myocardial infarction (MI), depending on whether or not acute revascularization was undertaken. Methods We assessed characteristics of and outcomes for patients who had a WCD prescribed in the first 3 months post-MI. The WCD medical order registry was searched for patients who were coded as having had a "recent MI with ejection fraction ≤35%" or given an International Classification of Diseases, Ninth Revision 410.xx diagnostic code (acute MI), and then matched to device-recorded data. Results Between September 2005 and July 2011, 8,453 unique patients (age 62.7 ± 12.7 years, 73% male) matched study criteria. A total of 133 patients (1.6%) received 309 appropriate shocks. Of these patients, 91% were resuscitated from a ventricular arrhythmia. For shocked patients, the left ventricular ejection fraction (LVEF) was ≤30% in 106, 30% to 35% in 17, >36% in 8, and not reported in 2 patients. Of the 38% of patients not revascularized, 84% had a LVEF ≤30%; of the 62% of patients revascularized, 77% had a LVEF ≤30%. The median time from the index MI to WCD therapy was 16 days. Of the treated patients, 75% received treatment in the first month, and 96% within the first 3 months of use. Shock success resulting in survival was 84% in nonrevascularized and 95% in revascularized patients. Conclusions During the 40-day and 3-month waiting periods in patients post-MI, the WCD successfully treated SCA in 1.4%, and the risk was highest in the first month of WCD use. The WCD may benefit individual patients selected for high risk of SCA early post-MI.
KW - defibrillation
KW - implantable cardioverter-defibrillator
KW - resuscitation
KW - sudden cardiac arrest
KW - wearable cardioverter-defibrillator
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U2 - 10.1016/j.jacc.2013.05.086
DO - 10.1016/j.jacc.2013.05.086
M3 - Article
C2 - 23916930
AN - SCOPUS:84888243713
SN - 0735-1097
VL - 62
SP - 2000
EP - 2007
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 21
ER -