All patients screened in whom an ICD had been implanted, either during this audit or previously, had an ICD indication in accordance with NICE guidance. In all but one case, this was a secondary prevention indication.
Twelve patients were identified who fulfilled NICE criteria for secondary prevention and did not undergo ICD implantation in January 2001. Two patients have undergone ICD implantation subsequently and a further patient had previously declined an ICD so was not included in further calculations. Three patients had ablative therapy considered by their cardiologists to be an alternative to ICD implantation, and one patient underwent VT stimulation study after a cardiac arrest where no sustained VT was induced. There was no evidence in the clinical records that ICD therapy had been considered in the remaining five patients.
Screening of patient contacts in January 2001 as recommended in the NICE guidance would have required a large number of additional investigations, shown in table 1. Extrapolation to include the results of full screening identified a further 10 patients with ICD indications giving a total of 21 additional ICDs in the month of January 2001. This represents a more than fourfold increase in ICD implantation from the current 29.7/106/year to around 125/106/year. This is an underestimate of the true increase as an average of only 3.7 ICDs per month were implanted during the previous year compared to the 5 ICDs implanted during the audit period.
Additional screening tests and ICDs required in one month to implement NICE guidelines