Assessing physician knowledge regarding indications for a primary prevention implantable defibrillator and potential barriers for referral.
Background Although there is clear evidence to demonstrate that primary prevention implantable defibrillators (ICDs) reduce mortality in high-risk patients, ICDs are underutilized. Limited data exist assessing referring physicians' knowledge about guideline indications and attitudes towards ICDs, wh...
| Publicado en: | Journal of Cardiovascular Electrophysiology Vol. 28; no. 11; pp. 1334 - 1342 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Nov2017
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=126202019&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 126202019 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10453873 GSB jtl: Journal of Cardiovascular Electrophysiology issn: 10453873 maglogo: Y pubinfo: dt: Nov2017 vid: 28 iid: 11 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 126202019 126202019 126202019 10.1111/jce.13326 126202019 ppf: 1334 ppct: 8 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Assessing physician knowledge regarding indications for a primary prevention implantable defibrillator and potential barriers for referral. aug: au: Bernier, Rochelle Raj, Satish R. Tran, Dat Reyes, Lucy Sauve, Michel Sumner, Glen L. Exner, Derek V. Sandhu, Roopinder K. affil: Mazankowski Alberta Heart Institute, Division of Cardiology, University of Alberta, Alberta Canada sug: subj: Electrophysiology Defibrillators, Implantable Quality Assurance Death, Sudden, Cardiac Physician Attitudes Knowledge Evaluation Human Referral and Consultation Health Services Accessibility Surveys ab: Background Although there is clear evidence to demonstrate that primary prevention implantable defibrillators (ICDs) reduce mortality in high-risk patients, ICDs are underutilized. Limited data exist assessing referring physicians' knowledge about guideline indications and attitudes towards ICDs, which may influence decision for referral. Methods and results The Arrhythmia Working Group from the Alberta Cardiovascular and Stroke Strategic Clinical Network developed a web-based survey consisting of case scenarios regarding primary prevention ICD indications and a list of barriers for referral to aid in the design of a complex device care pathway. We invited referring physicians to participate in the survey including internists and cardiologists and cardiology residents. The survey was completed by 109 of 799 (response rate = 14%) of physicians. Of those, 55% were internists, 32% cardiologists, and 13% cardiology residents. The majority of physicians were male (62%), practicing in a university hospital (66%). Overall, complete guideline-concordant answers were provided by 34% of physicians. In multivariable analysis, predictors of complete guideline concordance were being a cardiologist (odd ratio [OR] 5.9, confidence interval [CI] 2.1-16.4, P = 0.001) and cardiology resident (OR 6.7, CI 1.7-27.3, P = 0.007). The most common barrier for referral for internists was lack of confidence in knowledge of guideline recommendations; while cardiologists reported concerns about cost-effectiveness and cardiology residents were most concerned with inappropriate shocks. Conclusion Knowledge regarding indications for primary prevention ICD is limited and varies significantly among referring physicians. The barriers for referral differ among physician groups and addressing these identified barriers may help to improve appropriate ICD utilization. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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