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Identifying Patients at High Risk for Sudden Cardiac Arrest in Your Practice Patients at high risk for sudden cardiac arrest include those with EF ≤ 40%, particularly those with 1 EF ≤ 35%, regardless of etiology, with or without heart failure symptoms. Primary Screen Alternative Primary Screen Screen Medical Records Using ICD-9 Codes: 402 – Hypertensive heart disease with heart failure 404 – Hypertensive heart and renal disease with heart failure 410 – Acute myocardial infarction 411 – Acute coronary syndrome 412 – Old myocardial infarction 414 – Other forms of chronic ischemic heart disease 425 – Cardiomyopathy 428 – Heart Failure Screen all ventricular function studies for LVEF ≤ 35% Secondary Screening Information Screen Medical Records: Date of last office visit: ____________ _______ • Assess recent LV function: Document LVEF ______ ___ Date:__________________ • Assess ventricular dyssynchrony: document QRS duration from recent EKG QRS (ms) _____ __ Date: _________ _______ and/or measure of mechanical dyssynchrony Study: ____ ____ Measure: ______ ___ Date: _________________ • Assess medication regimen: Has optimal heart failure therapy with ACEI/ARB, evidence-based beta blocker, aldosterone antagonist been achieved? • Assess functional status and symptoms: NYHA Functional Class ____ __ Date: __________________ • Duration of HF symptoms: _______________ • Date of last MI: _______ ____ • Date of last cardiac surgery: _______ ____ Treatment Decision Point: Schedule patient follow-up to optimize/uptitrate medical therapy Schedule patient follow-up to assess LV function, QRS duration, NYHA Functional Class Assess for indications and contraindications to device therapy; see individual algorithms for details If patient eligible, initiate discussion with patient regarding risk for Sudden Cardiac Arrest and device options to reduce risk Refer to Sudden Cardiac Arrest fact sheets and Patient FAQ sheets to aid in patient discussion Checklist Patients with ischemic cardiomyopathy Patient is: At least 40 days post-MI and LVEF ≤ 30% and NYHA Functional Class I, II, or III and On chronic optimal medical therapy Patient does not have any of the following contraindications*: NYHA Class IV (unless eligible for CRT) or Cardiogenic shock or hypotension or CABG or PTCA within past 3 months or Candidate for coronary revascularization or Irreversible brain damage from preexisting cerebral disease or Other disease with survival < 1 year If all checked, refer for consideration of ICD placement Patients with ischemic or nonischemic cardiomyopathy Patient is: At least 40 days post-MI (if ischemic) At least 3 to 9 months (if nonischemic) LVEF ≤ 35% and NYHA Functional Class II or III and On chronic optimal medical therapy Patient does not have any of the following contraindications*: NYHA Class IV (unless eligible for CRT) or Cardiogenic shock or hypotension or CABG or PTCA within past 3 months or Candidate for coronary revascularization or Irreversible brain damage from preexisting cerebral disease or Other disease with survival < 1 year If all checked, refer for consideration of ICD placement CRT potential patient eligibility Patient has: LVEF ≤ 35% Sinus rhythm NYHA Functional Class III or Ambulatory Class IV On recommended optimal medical therapy QRS duration ≥ 120 ms Patient does not have any of the following contraindications*: Cardiogenic shock or hypotension or CABG or PTCA within past 3 months or Candidate for coronary revascularization or Irreversible brain damage from preexisting cerebral disease or Other disease with survival < 1 year If all checked, refer for consideration of CRT placement CRT-D – inclusion of CRT device with defibrillator should be based on ICD indications and physician discretion. * These contraindications are included in the expanded CMS Coverage Guidelines for ICDs, effective January 27, 2005. Reference 1 European Heart Rhythm Association; Heart Rhythm Society; Zipes DP, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death). J Am Coll Cardiol. September 5, 2006;48(5):e247-346. Developed by the SCA Prevention Medical Advisory Team. This is a general algorithm to assist in the management of patients. This clinical tool is not intended to replace individual medical judgment or individual patient needs. Please refer to the manufacturers’ prescribing information and/or instructions for use for the indications, contraindications, warnings, and precautions associated with the medications and devices referenced in these materials. Sponsored by Medtronic, Inc. April 2007 UC200705404 EN