Open AccessImplementation of MADIT and MUSTT in Clinical Practice: Results of an International Survey
Author(s) -
Nisam Seah,
Henry Sophie,
Wilber David J.
Publication year - 2002
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/j.1542-474x.2002.tb00191.x
Subject(s) - medicine , clinical trial , clinical practice , implantable cardioverter defibrillator , randomized controlled trial , multicenter trial , ventricular tachycardia , multicenter study , family medicine
Background: The long‐awaited dramatically positive outcome of the Multicenter Automatic Defi‐brillator Implantation Trial (MADIT II), just published by Moss et al.,14 has generated cardiologists’interest on the implementation into clinical practice of that trial. Important lessons may be learned by examining the clinical implementation of two preceding randomized, prospective, prophylactic ICD trials: the original MADIT trial, published late 1996, and the Multicenter Unsustained Tachycardia Trial (MUSTT), published late 1999. Both demonstrated that implantable cardioverter defi‐brillators reduce all‐cause mortality by over 50% in high risk patients without previous sustained arrhythmias. Methods: In early 2000, we surveyed 133 active electrophysiology centers (47 American, 81 European, 5 Canadian) to determine the extent to which these practices have been implemented in clinical practice during 1999, and the responses were compared to a similar survey for the year 1998. Results: ICDs implanted for MADIT or MUSTT criteria accounted for 18% of new ICD implants in 1999, 65% greater than in 1998, increasing from 6% to 11% in Europe, and from 15% to 24% in America. During 1999, 53% of patients receiving ICDs for these indications were inpatients identified during hospitalization, 27% were outpatients referred specifically for MADIT/MUSTT indications, and 20% were identified by routine screening. Per the survey, in 1999 68% of responders were “somewhat 10–20%)” and 14% were “considerably (>20%)” more likely to implant ICDs for all indications. Conclusions: Extrapolating the results of this survey to all initial ICD implants for 1999, we estimate that 8500 implants for MADIT/MUSTT criteria took place in 1999, with the overall number of such implants substantially increased over the previous year, irrespective of geographic location, and influenced significantly by the publication of MUSTT. However, screening and implant practices between centers continue to vary over a broad spectrum. It will be interesting to observe whether similar patterns will follow with MADIT II. A.N.E. 2002;7(4):399–405