• Amar Mistry, Zakariyya Vali, Abu Taher, Bharat Sidhu, Xin Li, Michelle Newton, and Ghulam Andre Ng.
• Department of Cardiovascular Science, University of Leicester, Leicester, UK amarmistry@nhs.net.
• Postgrad Med J. 2019 Apr 1; 95 (1122): 205-209.

PurposeImplantable cardioverter defibrillator (ICD) implantation rates remain variable despite established guideline recommendations. This study aims to assess whether being managed by a cardiologist has an impact on whether patients are considered for an ICD for primary prevention of sudden cardiac death.Design/MethodsSingle-centre, retrospective, observational study of patients identified to have severe left ventricular systolic dysfunction (LVSD) on echocardiography (n = 129) between 1 and 30 June 2016 with cross-sectional assessment at 1 year. An assessment of ICD consideration at 1 year following the echocardiogram was documented, in addition to the specialty of the managing physician (group 1-electrophysiologist/heart failure specialist; group 2-all other cardiologists; group 3-non-cardiologist).Results129/1173 (11%) transthoracic echocardiographies (s) were identified to have severe LVSD. 52 (40%), 37 (29%) and 40 (31%) were managed by group 1, group 2 and group 3, respectively. Mean age was 74.7 (±12.6) years with a predominance of male gender (70.5%). An ICD was not considered in 47.3%. Those managed by a cardiologist were more likely to be considered for an ICD than a non-cardiologist (63.9% vs 30.0%; OR 4.0, 95% CI 1.8 to 8.8, p = 0.001) with a greater survival at 1 year (89.9% vs 52.5%, OR 8.1 95% CI 3.2 to 20.4, p < 0.001). Group 1 were more likely to consider ICD than group 2 cardiologists (75.0% vs 45.9%; OR 3.5; 95% CI 1.4 to 8.7, p = 0.005).ConclusionThere is significant variation between cardiologists and non-cardiologists, as well as within different cardiology subspecialists, when considering the option of ICD therapy for primary prevention.© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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