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In September 2000, the National Institute for Clinical Excellence (NICE) published guidance on implantable cardioverter-defibrillator (ICD) therapy for both primary and secondary prevention of sudden cardiac death. (1) NICE anticipated that its guidance would require the implantation of approximately 50 first and replacement devices per million of the population per year, equivalent to 40/[10.sup.6]/year first devices. (2) In 2000, the ICD implantation rate in the UK and Republic of Ireland was 15.4 per million first implants and 3.64 per million generator replacements, (2) little more than one third of the number recommended by NICE. We therefore audited our practice against this guidance to define the implications of its implementation and the magnitude of the current shortfall.
A total of 1637 adult cardiac patient contacts with Freeman Hospital in January 2001 were audited against the standard published as NICE guidance. (1) The records of all patients admitted to the cardiac care unit (CCU) (144), and all adults undergoing echocardiography (737), Holter monitoring (126), exercise tolerance testing (142), open heart surgery (115), coronary angiography (205), ventricular tachycardia (VT) stimulation study (5) or ICD implantation (5) during one month, and all patients seen in one week's cardiology outpatient clinics (194) were reviewed for primary and secondary indications for ICD implantation. The number of patients seen in clinic was extrapolated to a 12th of the number of patients seen annually. …