Introduction: The implantable cardioverter defibrillator (ICD) reduces mortality in patients at risk for potentially life-threatening arrhythmias. Access and distribution of ICDs in rural or economically disadvantaged populations is suspected to be low. This study examined Out of Hospital Premature Natural Death data (OHPND) and electronic medical record (EMR) data to identify rates of non-implantation of ICDs in a sample of decedents in eastern North Carolina. Methods and Results: Death certificate information on 1,316 decedents were matched with EMR data (N = 967, 73.4%). Chart review identified 70 (7.2%) potential ICD candidates with a left ventricular ejection fraction (LVEF) ≤35%. Of the 70 identified patients, 5 (7.1%) did not meet criteria because LVEF subsequently improved. Of the remaining 65 patients, 32 (49.2%) already received an ICD or a wearable cardioverter-defibrillator (WCD), and 33 patients (50.7%) met ICD implantation criteria but had not received one. The reasons identified for non-implantation of ICDs included: limited life expectancy secondary to comorbidities, principally chronic kidney disease (CKD) (N=11, 17%), lack of physician adherence to guidelines (N=9, 14%), lost to follow-up (N=7, 11%), patient refusal (N=5, 8%), and patients yet to commence guideline-directed medical therapy (N=1, 2%). Among our cohort of 967 individuals who died unexpectedly at home, 9 (0.9%) patients may have avoided unexpected death with an ICD/WCD. Conclusion: This study using decedent data shows low rates of ICD-underutilization in a rural population, but also emphasizes the role that advanced comorbidities such as CKD play in ICD-underutilization.
Abstract Background: The patient experience of atrial fibrillation (AF) involves several daily self-care behaviors and ongoing confidence to manage their condition. Currently, no standardized self-report measure of AF patient confidence exists. The purpose of this study is to establish the reliability and validity of a newly developed confidence in AF management measure. Methods: This study provides preliminary analysis of the Confidence in Atrial FibriLlation Management (CALM) scale, which was rationally developed to measure patient confidence related to self-management of AF. The scale was provided to a sample of AF patients N=120, (59% male) electronically through a patient education platform. Principle components analysis (PCA) and Cronbach’s alpha were employed to provide preliminary assessment of the validity and reliability of the measure. Results: PCA identified a four-factor solution. Internal consistency of the CALM was considered excellent with Cronbach’s α = .910. Additional PCA confirmed the value of a single factor solution to produce a total confidence score for improved utility and ease of clinical interpretation. Conclusions: Initial assessment of a novel scale measuring patient confidence in managing AF provided promising reliability and validity. Patient confidence in self-management of AF may prove useful as a key marker and endpoint of the patient experience beyond QOL.
EDITORIAL: Modern Atrial Fibrillation Care: Becoming a Pro at Using PROsSamuel F. Sears, PhD,1,2 Scarlett Anthony, BA,1 & Aditi Naniwadekar, MD21 Department of Psychology, East Carolina University, Greenville, NC2 Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC