Compliance with Guideline-Directed Medical Therapy and Early Implantable Cardioverter-Defibrillator Activation in Heart Failure: A Retrospective Study

Scientific paper - Original scientific paper

• Author: Ivan Prepolec
• Author: Vedran Pašara
• Author: Andrija Nekić
• Author: Jakov Emanuel Bogdanić
• Author: Jurica Putrić Posavec
• Author: Borka Pezo Nikolić
• Author: Miroslav Krpan
• Author: Richard Matasić
• Author: Mislav Puljević
• Author: Martina Lovrić Benčić
• Author: Davor Puljević
• Author: Davor Miličić
• Author: Carlo de Asmundis
• Author: Gian Battista Chierchia
• Author: Giacomo Mugnai
• Author: Vedran Velagić
• Author's institution: University of Zagreb; School of Medicine; (Department of Internal Medicine)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract (english)

Background: This study was conducted to evaluate compliance with guideline-directed optimal medical therapy (OMT) and its association with early implantable cardioverter-defibrillator (ICD) activation in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Retrospective data from 307 patients who underwent ICD implantation for primary prevention from 2011 to 2017 were collected and analyzed.
Results: Among the study participants, only 23.8% received the maximum tolerated dose of OMT prior to ICD implantation, with 59.0% receiving all three OMT medication groups. No significant difference in OMT compliance was found between patients with ischemic cardiomyopathy (ICM) and those with non-ischemic dilated cardiomyopathy (DCM). However, DCM patients received ICDs more frequently at the time of diagnosis than ICM patients (13.8% vs. 0.7%). Early ICD activation (within 3 months) occurred in only one patient who had not received appropriate OMT, representing 0.7% of all ICM patients. Furthermore, early activation was also infrequent in patients who received OMT (2.9% of ICM patients and 2.6% of DCM patients). Echocardiography follow-up data revealed that 20.4% of ICM patients and 29.8% of DCM patients who did not receive OMT before ICD implantation showed improvement in the left ventricular ejection fraction (EF) to 35% or more. Conclusions: This study found suboptimal compliance with OMT prior to ICD implantation in HFrEF patients. The results showed that early ICD activation was rare in all patient groups, especially those who did not receive the prescribed 3 months of OMT. More research is needed to investigate longer waiting periods for the evaluation of potential EF improvement, and to better evaluate the eligibility of HFrEF patients for ICD. The current findings have potential implications for clinical practice and patient outcomes.

• Keywords (english): compliance; guideline-directed medical therapy; heart failure; implantable cardioverter-defibrillator
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Reviews in Cardiovascular Medicine
• Numbering: vol. 25, no. 3, 75
• p-ISSN: 1530-6550
• e-ISSN: 2153-8174
• DOI: https://doi.org/10.31083/j.rcm2503075
• URN:NBN: urn:nbn:hr:105:091210
• Publication: 2024-02-27
• Document URL: https://www.imrpress.com/journal/RCM/25/3/10.31083/j.rcm2503075
• Type of resource: Text
• Access conditions: Open access
• Created on: 2025-04-01 10:46:29