An audit of the implications of implementing NICE guidance on the use of implantable cardioverter-defibrillators

Abstract

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. Because there was no systematic screening of myocardial infarction (MI) survivors for ICD indications, extrapolations were made from published data^{3, 4} of the consequences of the investigations required for full screening.