European Society of Cardiology Risk Model Reduces Implantable Cardiodefibrillator Use in Hypertrophic Cardiomyopathy
Sudden cardiac death (SCD) as a result of ventricular arrhythmias is an important cause of cardiovascular mortality in patients with hypertrophic cardiomyopathy.1,2 Clinical trials of implantable cardiodefibrillators (ICDs) have demonstrated effectiveness at preventing SCD and prolonging life expectancy in high-risk patients.3 However, ICDs are not without complications. As such, management of hypertrophic cardiomyopathy requires careful risk assessment. In order to help physicians assess risk in these patients and identify those patients at high risk of SCD, the American College of Cardiology Foundation (ACCF), American Heart Association (AHA) and the European Society of Cardiology (ESC) have developed guidance. However, the predictive accuracy of the 2014 ESC novel risk-scoring model has been questioned. A recent study published in the American Journal of Cardiology independently evaluated the ESC risk scoring system in a large cohort of patients with hypertrophic cardiomyopathy and compared this with the previous ACCF/AHA guidelines from 2011 and 2003.4
The researchers reviewed data from 288 patients who were being treated at Imperial College London NHS Trust. The mean age of the study population was 52 ± 16 years, with 66% men. In the SCD group (n=14, mean age 41 ± 18 years, 71% male), there were a larger proportion of patients in whom an ICD would not have been recommended using the 2014 ESC scoring criteria compared with ACCF/AHA guidance (43% versus 7%, p = 0.029). A total of 274 patients with hypertrophic cardiomyopathy did not experience an SCD event, and a larger proportion of individuals not requiring an ICD was identified using the 2014 ESC risk score model compared with the 2011/2003 ACCF/AHA models (82% versus 57%; p<0.0001). In addition, the study revealed that five patients who experienced an aborted SCD event would not have been recommended an ICD with the ESC risk score model compared with the ACCF/AHA guidelines.
The authors concluded that the 2014 ESC model has the potential of leaving more patients at risk of SCD without an ICD. While unnecessary placement of ICD is to be avoided, it is also imperative that those at high risk of SCD are identified, and that SCD is avoided in these patients.
Disclosure: Emma East is an employee of Touch Medical Media.
1. Mendis SPP, Norrving B. Global Atlas on Cardiovascular Disease Prevention and Control. Geneva: World Health Organization, 2011. Available at: www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/ (accessed 30 January 2018).
2. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2015;36:2793–867.
3. Goldenberg I, Gillespie J, Moss AJ, et al. Long-term benefit of primary prevention with an implantable cardioverter-defibrillator: an extended 8-year follow-up study of the Multicenter Automatic Defibrillator Implantation Trial II. Circulation. 2010;122: 1265–71.
4. Leong KMW, Chow JJ, Ng FS, et al. Comparison of the Prognostic Usefulness of the European Society of Cardiology and American Heart Association/American College of Cardiology Foundation Risk Stratification Systems for Patients With Hypertrophic Cardiomyopathy. Am J Cardiol. 2018;121:349–55.