• Ben McHale, Scott A Harding, Nigel A Lever, and Peter D Larsen.
• Department of Surgery and Anaesthesia, University of Otago, Wellington, New Zealand.
• Europace. 2009 Oct 1;11(10):1313-6.

AimsThis study surveyed referring clinicians to identify barriers that may contribute to New Zealand's low national implantable cardioverter defibrillator (ICD) implant rate.MethodsWe conducted a telephone survey of 100 cardiologists and general physicians working at 30 different New Zealand hospitals who routinely manage patients with ischaemic heart disease and heart failure.ResultsThe majority of those surveyed (76%) rated their knowledge as satisfactory or better, although only 62% reported familiarity with international guidelines for ICD therapy. When asked to identify ICD indications 80% identified symptomatic or sustained ventricular arrhythmias and 73% left ventricular dysfunction. While 82% believed that the use of ICD therapy for secondary prevention was cost effective, only 53% believed they were cost effective for primary prevention. Lack of financial resource (88%), lack of local expertise (61%), lack of New Zealand guidelines (51%), and the referral process (43%) were seen as significant barriers to ICD referral by many participants. The majority of rural clinicians (71%) identified restricted access to investigations as a barrier to implantation, significantly higher than urban clinicians (18%, P = 0.001).ConclusionWe have identified a number of potential barriers that will need to be addressed to raise the New Zealand ICD implantation rate.

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