Abstract
IntroductionCurrent guidelines recommend ICD implantation for secondary prevention of sudden cardiac death (SCD) in survivors of sudden cardiac arrest (SCA), except in those with completely reversible causes. There is limited data about adherence to these guidelines.HypothesisWe assessed adherence to the ACCF/AHA/HRS guidelines in SCA patients and which factors were associated with improved survival.MethodsWe retrospectively reviewed the records of 646 patients managed at the University of Pittsburgh Medical Center (UPMC) from 2002 to 2012 who were discharged alive after a SCA. A reversible SCA cause was defined as (i) significant electrolyte or metabolic abnormality, (ii) evidence of acute myocardial infarction, (iii) evidence of cardiac ischemia and (iv) recent initiation of antiarrhythmic drug or illicit drug use.ResultsAmong 646 SCA patients (age 64.1±15.4 years, 59% male, 83% white, QRS=104±29 ms, modified Charlson comorbidity index =1.93±2.13, 58% with in-hospital SCA), 48.5% had ventricular fibrillation, flutter or tachycardia as the initial rhythm, and ICDs were implanted in 25% of cases. A reversible SCA cause was identified in 67% of patients; these causes were corrected 76% of the time. Of those whose SCA causes were successfully reversed, 74% did not get ICDs. In patients without a clearly reversible or a reversible cause that was not reversed, 23% got ICDs. Overall, the compliance rate with guidelines was ~49%. After a mean follow up of 3.1±2.9 years, 49% of patients were dead. After adjusting for all relevant covariates, including SCA location and modified Charlson comorbidity index, in a cox regression model, the presence of a reversible cause of SCA (HR 0.694, p-value 0.014) and ICD implantation (HR 0.506, p-value <0.001) were independent predictors of better survival.ConclusionsThe overall compliance with ICD implantation guidelines following SCA was mediocre. The presence of a reversible SCA cause and ICD implantation were independently associated with better long-term survival.