Improve the Prevention of Sudden Cardiac Arrest in Patients With Post-Acute Myocardial Infarction.

Background: Implantable cardioverter-defibrillator (ICD) implantation to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients varies by geography but remains low in many regions despite guideline recommendations.
Objectives: This study aimed to characterize the care pathway of post-MI patients and understand barriers to referral for further SCD risk stratification and management in patients meeting referral criteria.
Methods: This prospective, nonrandomized, multi-nation study included patients ≥18 years of age, with an acute MI ≤30 days and left ventricular ejection fraction <50% ≤14 days post-MI. The primary endpoint was defined as the physician's decision to refer a patient for SCD stratification and management.
Results: In total, 1,491 post-MI patients were enrolled (60.2 ± 12.0 years of age, 82.4% male). During the study, 26.7% (n = 398) of patients met criteria for further SCD risk stratification; however, only 59.3% of those meeting criteria (n = 236; 95% CI: 54.4%-64.0%) were referred for a visit. Of patients referred for SCD risk stratification and management, 94.9% (n = 224) attended the visit of which 56.7% (n =127; 95% CI: 50.1%-63.0%) met ICD indication criteria. Of patients who met ICD indication criteria, 14.2% (n = 18) were implanted.
Conclusions: We found that ∼40% of patients meeting criteria were not referred for further SCD risk stratification and management and ∼85% of patients who met ICD indications did not receive a guideline-directed ICD. Physician and patient reasons for refusing referral to SCD risk stratification and management or ICD implant varied by geography suggesting that improvement will require both physician- and patient-focused approaches. (Improve Sudden Cardiac Arrest [SCA] Bridge Study; NCT03715790).
Competing Interests: This study was funded by Medtronic Inc. Dr Zhang has received speaker fees/consulting fees from Boston Scientific, Medtronic, Abbott, and Biotronik; and has received steering committee fees from Medtronic. Dr Chen has received honorariums from Medtronic, Biotronik, Abbott, and Boston Scientific. Dr Liew has received speaker fees and honorarium from Medtronic and Boston Scientific. Dr Haggui has received honorariums from Medtronic, Abbott, and Boston Scientific. Dr Ong has received speaker/consultant fees from Boston Scientific, Medtronic, Abbott Vascular, Biotronic, OrbusNeich, Alvimedica, B Braun, Novartis, AstraZeneca, Bayer, and Boehringer Ingelheim. Dr Rungpradubvong has received honoraria from Medtronic, Abbott, Boston Scientific, Biotronik, Johnson & Johnson, Pfizer, Daiichi Sankyo, Boehringer Ingelheim, and Bayer. Dr Wang has received honorariums from Medtronic, Abbott, and Biotronik. JinKyung Jeon, Grace Wong, Dr Lemme, Brian Van Dorn, and Dr Lexcen are employees of Medtronic Inc. Dr Huang has received speaker fees/consulting fees from Boston Scientific, Bayer, Boehringer-Ingelheim, and Abbott. All other authors have reported that there are no relationships relevant to the contents of this paper to disclose.
(© 2022 The Authors.)