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Published in the Journal of the American College of Cardiology (JACC), the 2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death is an evidence-based clinical guideline developed by leaders in the field of cardiovascular medicine, representing the broadest formal recommendations to date for use of the WCD.
Rahul Doshi, MD, Director of Electrophysiology, Keck Medical Center of University of Southern California stated, “Clinical evidence has clearly shown that low-EF patients benefit from WCD protection during the period of highest SCD risk following a heart attack, new diagnosis of heart failure, or other acute cardiac event.” He adds, “These guidelines highlight the need for electrophysiologists to partner with our interventional cardiologist and heart failure specialist colleagues to implement screening protocols to identify all low-EF patients who should be offered WCD therapy in the early period after a cardiac event.”
Ejection fraction (EF) is the most powerful predictor of long-term mortality.1 Numerous clinical studies demonstrate the risk of mortality is highest in the first 90 days following a cardiac event, such as a heart attack or new diagnosis of heart failure, including high mortality from SCD.1,2,3,4,5,6
“Inclusion of the WCD in these guidelines is a call to action for clinicians to identify all patients who are indicated for the therapy,” commented David E. Kandzari, MD, Director of Interventional Cardiology and Cardiovascular Research, Piedmont Heart Institute. “By setting this standard in our practices and institutions, we can ensure that all indicated patients are protected during the period of highest SCD risk while we determine their best long-term care plan.”
Extensive clinical evidence supports WCD use for protection from SCD in the early period following a cardiac event. In the WEARIT-II Registry of 2,000 WCD patients, authors concluded that the WCD demonstrated both safety and efficacy in this large patient cohort with ischemic, non-ischemic, and congenital or inherited heart disease.7 A high rate of sustained VT/VF was observed at three months in at-risk patients.7 Following WCD use, 41% of patients experienced EF improvement and 42% received an ICD.7
“We are very pleased to see that these leading cardiology societies have published comprehensive recommendations for WCD use,” commented Jason T. Whiting, President of ZOLL LifeVest. “The implementation of these recommendations into clinical practice will save even more patients’ lives from sudden cardiac death.”
In addition to the AHA/ACC/HRS guidelines, the WCD is included in the European Society of Cardiology guidelines for the management of patients at risk for SCD, including post-MI and newly diagnosed heart failure patients.
On any given day, tens of thousands of people around the world are protected from SCD by the LifeVest® Wearable Defibrillator. The LifeVest is used for a wide range of patient conditions or situations, including following a myocardial infarction, before or after coronary revascularization, and for those with cardiomyopathy or congestive heart failure that places them at particular risk. The LifeVest gives physicians time to optimize medical therapy and assess a patient’s long-term risk for sudden death.
1Halkin A et al. Prediction of mortality after primary percutaneous coronary intervention for acute myocardial infarction: CADILLAC risk score. J Am Coll Cardiol 2005;45:1397–1405.
2Solomon SD et al. Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. NEJM 2005;352:2581–2588.
3Adabag AS et al. Sudden death after myocardial infarction. JAMA 2008;300(17):2022–2029.
4Zishiri ET et al. Early risk of mortality after coronary artery revascularization in patients with left ventricular dysfunction and potential role of the wearable cardioverter defibrillator. Circ Arrhythm Electrophysiol 2013;6:117–128.
5Weintraub W et al. Prediction of long-term mortality after percutaneous coronary intervention in older adults: Results from the National Cardiovascular Data Registry. Circulation 2012;125:1501–1510.
6Packer M et al. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. NEJM 1996;334(21):1349–1355.
7Kutyifa V et al. Use of the wearable cardioverter defibrillator in high-risk cardiac patients: Data from the prospective registry of patients using the wearable cardioverter defibrillator (WEARIT-II Registry). Circulation 2015;132(17):1613–1619.