Download Identifying Patients at High Risk for Sudden Cardiac Arrest in Your

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
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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