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Randomized Controlled Trial
. 2013 Oct;166(4):737-43.
doi: 10.1016/j.ahj.2013.07.019. Epub 2013 Sep 5.

Failure to Reassess Ejection Fraction After Acute Myocardial Infarction in Potential Implantable Cardioverter/Defibrillator Candidates: Insights From the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) Registry

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Free PMC article
Randomized Controlled Trial

Failure to Reassess Ejection Fraction After Acute Myocardial Infarction in Potential Implantable Cardioverter/Defibrillator Candidates: Insights From the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) Registry

Amy Leigh Miller et al. Am Heart J. .
Free PMC article

Abstract

Background: Current practice guidelines advocate delaying assessment of primary prevention implantable cardioverter/defibrillator (ICD) candidacy at least 40 days after an acute myocardial infarction (AMI) because early ICD implantation after AMI has not demonstrated survival benefit. The rate at which interval reassessment of left ventricular ejection fraction (LVEF) occurs in potential primary prevention ICD candidates is unknown.

Methods: We examined patients with AMI in the TRIUMPH registry with inhospital LVEF <40% discharged alive after their index presentation, excluding patients with a prior ICD and those who declined ICD during the index admission or were discharged to hospice. We conducted multivariable Poisson modeling to identify independent factors associated with LVEF reassessment by 6 months after AMI.

Results: Of the 533 patients meeting the inclusion criteria, only 187 (35.1%) reported LVEF reassessment in the first 6 months after AMI and only 13 patients (2.4%) underwent ICD implantation by 1 year. In multivariable analysis, early cardiology follow-up after AMI was associated with a higher likelihood of LVEF reassessment (odds ratio 1.16, 95% confidence interval 1.06-1.28), whereas uninsured status and cardiologist-driving inpatient medical decision making were associated with a lower likelihood of LVEF reassessment (odds ratios 0.84 [95% CI 0.74-0.96] and 0.78 [95% CI 0.68-0.91], respectively).

Conclusions: In contemporary practice, almost 2 of 3 potential primary prevention ICD candidates did not report follow-up LVEF evaluation, with a very low rate of ICD implantation at 1 year. These results suggest an important gap in quality, highlighting the need for better transitions of care.

Conflict of interest statement

Disclosures: Drs. Miller, Chan, Ho, Daugherty, Rathore, P. Peterson, Lanfear, and Ms. Gosch have no conflicts of interest. Dr. Spertus has research grants/contracts from the National Heart Lung and Blood Institute, the American Heart Association, the American College of Cardiology Foundation, Lilly, EvaHeart, Genentech, and Gilead; provides consultant services to St. Jude Medical, Gilead, Amgen, Genentech, Janssen, and United Healthcare; has copyrights/patents on the Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire, and the Peripheral Artery Questionnaire; and serves as the President of CV Outcomes, Inc, President of Outcomes Instruments, and a Board Member and founder of Health Outcomes Sciences. Dr. Wang has research grants/contracts with AstraZeneca, Gilead, Lilly, The Medicines Company, and Canyon Pharmaceutical, and provides consulting or other services for MedCo and the American College of Cardiology. Dr. E. Peterson has research grants from Eli Lilly and Company, Ortho-McNeil-Janssen Scientific Affairs, the Society of Thoracic Surgeons, the American Heart Association, and the American College of Cardiology; he provides consulting or other services to AstraZeneca, Boehringer Ingelheim, Genentech, Ortho-McNeil-Janssen Pharmaceuticals, Pfizer, WebMD, and Sanofi-Aventis.

Figures

Figure 1
Figure 1
Variation in LVEF assessment rate across participating sites.
Figure 2
Figure 2
Multivariable analysis of factors associated with LVEF reassessment; hazard ratio and 95% confidence intervals are shown in the right-hand column.

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