Abstract：
OBJECTIVE: The indication for implantable cardioverter defibrillator (ICD) for sudden cardiac death (SCD) prevention relies mostly on left ventricular ejection fraction (LVEF) ≤ 35%. The use of a wearable cardioverter defibrillator (WCD) in the case of dynamic alterations of LVEF may help avoid an improper early ICD implant when a favourable evolution in the post-acute phase is observed and may help reduce costs.
METHODS: This parallel cohort retrospective study included patients with heart failure with reduced ejection fraction (HFrEF) at high risk of arrhythmias recruited in the acute phase and divided into an early ICD cohort and a WCD cohort for primary prevention during the waiting period established by European Society of Cardiology guidelines.
RESULTS: A total of 41 consecutive patients were enrolled: 26 in the WCD group and 15 in the early ICD group. Age, LVEF at baseline, causes of HFrEF and drug therapy in the two cohorts were similar. During the waiting period after the inclusion, three patients (11.5%) in the WCD cohort and four (26.7%) in the early ICD cohort developed relevant ventricular arrhythmias (P = 0.22); none of them had subsequent LVEF recovery. At the end of the waiting period, 13 patients (50%) in the WCD group and 7 (46.7%) in the early ICD group experienced LVEF recovery (P = 0.84). The average cost per patient at the end of the waiting period was €23 934 in the early ICD cohort versus €19 167 in the WCD cohort (-19.9%). This cost savings from WCD use appears even higher when projected over a 10 year period (-41.2%).
CONCLUSIONS: WCD may represent a cost-effective strategy to more accurately select candidates for the primary prevention ICD implant among high-risk patients with HFrEF. ICD use provides effective protection from SCD and reduces costs compared with an extensive early ICD implant.
METHODS: This parallel cohort retrospective study included patients with heart failure with reduced ejection fraction (HFrEF) at high risk of arrhythmias recruited in the acute phase and divided into an early ICD cohort and a WCD cohort for primary prevention during the waiting period established by European Society of Cardiology guidelines.
RESULTS: A total of 41 consecutive patients were enrolled: 26 in the WCD group and 15 in the early ICD group. Age, LVEF at baseline, causes of HFrEF and drug therapy in the two cohorts were similar. During the waiting period after the inclusion, three patients (11.5%) in the WCD cohort and four (26.7%) in the early ICD cohort developed relevant ventricular arrhythmias (P = 0.22); none of them had subsequent LVEF recovery. At the end of the waiting period, 13 patients (50%) in the WCD group and 7 (46.7%) in the early ICD group experienced LVEF recovery (P = 0.84). The average cost per patient at the end of the waiting period was €23 934 in the early ICD cohort versus €19 167 in the WCD cohort (-19.9%). This cost savings from WCD use appears even higher when projected over a 10 year period (-41.2%).
CONCLUSIONS: WCD may represent a cost-effective strategy to more accurately select candidates for the primary prevention ICD implant among high-risk patients with HFrEF. ICD use provides effective protection from SCD and reduces costs compared with an extensive early ICD implant.
摘要：
目的：植入式心律转复除颤器（ICD）预防心源性猝死（SCD）的适应症主要取决于左心室射血分数（LVEF）≤35％。在LVEF动态改变的情况下，使用可穿戴的心律转复除颤器（WCD）可以帮助避免在急性期后观察到有利的演变时早期ICD植入不当，并且可以帮助降低成本。
方法：这项平行队列回顾性研究纳入了在急性期招募的具有高心律失常风险的射血分数降低（HFrEF）的心力衰竭患者，并分为早期ICD队列和WCD队列，以在等待期间进行一级预防由欧洲心脏病学会指南建立。
结果：共纳入41例连续患者：WCD组26例，早期ICD组15例。年龄,基线LVEF,两个队列中HFrEF的病因和药物治疗相似.在纳入后的等待期内，WCD队列中的3例患者(11.5%)和ICD早期队列中的4例患者(26.7%)发生了相关的室性心律失常(P=0.22);他们中没有人随后LVEF恢复.等待期结束时,WCD组13例(50%)和早期ICD组7例(46.7%)LVEF恢复(P=0.84)。等待期结束时，早期ICD队列中每位患者的平均费用为23.934欧元，而WCD队列中的19.167欧元（-19.9％）。WCD使用的成本节省在10年期间预计甚至更高(-41.2%)。
结论：WCD可能是一种具有成本效益的策略，可以更准确地在HFrEF高危患者中选择ICD植入一级预防的候选者。与广泛的早期ICD植入物相比，ICD的使用提供了对SCD的有效保护，并降低了成本。
方法：这项平行队列回顾性研究纳入了在急性期招募的具有高心律失常风险的射血分数降低（HFrEF）的心力衰竭患者，并分为早期ICD队列和WCD队列，以在等待期间进行一级预防由欧洲心脏病学会指南建立。
结果：共纳入41例连续患者：WCD组26例，早期ICD组15例。年龄,基线LVEF,两个队列中HFrEF的病因和药物治疗相似.在纳入后的等待期内，WCD队列中的3例患者(11.5%)和ICD早期队列中的4例患者(26.7%)发生了相关的室性心律失常(P=0.22);他们中没有人随后LVEF恢复.等待期结束时,WCD组13例(50%)和早期ICD组7例(46.7%)LVEF恢复(P=0.84)。等待期结束时，早期ICD队列中每位患者的平均费用为23.934欧元，而WCD队列中的19.167欧元（-19.9％）。WCD使用的成本节省在10年期间预计甚至更高(-41.2%)。
结论：WCD可能是一种具有成本效益的策略，可以更准确地在HFrEF高危患者中选择ICD植入一级预防的候选者。与广泛的早期ICD植入物相比，ICD的使用提供了对SCD的有效保护，并降低了成本。
