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Background: Use of Guideline-Directed Medical Therapy (GDMT) in patients with Heart Failure reduced Ejection Fraction (HFrEF) has been proven to reduce mortality and morbidity. The role of the Wearable Cardioverter Defibrillator (WCD) in new HFrEF patients is uncertain (AHA Guideline II-B). The central hypothesis in this study is that HFrEF patients do not consistently receive GDMT and that the use of WCD results in improved guideline compliance during the initial three month follow-up.
Methods: This study performed a retrospective analysis of data in 1,289 patients hospitalized and diagnosed with HFrEF from 2013-2015 in the electronic health record system. Excluded were those patients with a do not resuscitate order or deceased during the index hospitalization. The use of GDMT consisted of Beta Blocker and Angiotensin-Converting-Enzyme Inhibitors / Angiotensin II Receptor Blockers in patients with HFrEF. The study then compared patients who received a WCD to those who did not during the index HFrEF hospitalization. Additional outcomes, including follow-up echocardiograph (3-6 months) and indication for primary prevention implantable cardioverter defibrillator (ICD), were also assessed. Patients who demonstrated a contraindication to GDMT, declined a WCD, declined an echocardiograph, or refused an ICD were not included in the analysis. Statistical analysis was conducted using chi-squared test for independence (SPSS v.24.0).
Results: The use of WCD was significantly associated with the adherence to GDMT, X2 (1, N = 981) = 33.36, p<0.001. Further data analysis revealed that use of WCD was also significantly associated with recommendation for follow up echocardiograph, X2 (1, N = 865) = 66.94, p<0.001. Moreover, the use of primary prevention ICD was significantly greater in the WCD cohort compared to the non-WCD cohort, X2 (1, N = 1093) = 19.00, p<0.001.
Conclusions: The current study demonstrates that the use of WCD is associated with improved GDMT and follow-up echocardiographic studies and appropriate use of primary prevention ICD. Thus the potential benefits of WCD extend beyond prevention of sudden cardiac death to enhanced optimization of guideline directed therapy.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Heart Failure and Cardiomyopathies: Heart Failure Gadgets Galore
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1199-247
- 2017 American College of Cardiology Foundation