Knowledge Gaps in Implantable Cardioverter Defibrillator Therapy: a Survey of Trainees in Internal Medicine and Cardiology

Background: Knowledge of clinical practice guidelines for Implantable Cardioverter Defibrillator (ICD) therapy is a pre-requisite for effective application of this life-saving technology. The level of trainee familiarity with these guidelines is unknown. The objective of this study was to assess trainee familiarity with clinical practice guidelines for ICD therapy. Methods: This study surveyed 32 clinicians of varying training levels in internal medicine and cardiology at a large VA medical center. This is a survey study conducted from a population of all trainees in internal medicine at the medical center; the sample included trainees from PGY-1 through PGY-7 as well as attending physicians in internal medicine. Analysis of the collected survey data was performed using either Chi-square tests for comparison of categorical variables or unpaired t-tests for comparison of means. Results: Of all respondents, 69% reported that they were familiar with published guidelines, and consistent with previously published data. Cardiologists were significantly more likely to report familiarity than internists (85% vs 42%, P=0.01). Most respondents (75%) reported satisfactory or better knowledge of published guidelines, though only 34% self-reported their knowledge as good or very good. The majority of respondents (86%) underestimated the usual cost of ICD implantation, while most respondents (78%) agreed that implantation of an ICD was cost-effective for secondary prevention, cardiologists were far more likely to agree than internists (95% vs. 50%, P 0.03). Conclusion: There are considerable knowledge gaps evident among trainees with regard to clinical practice guidelines for ICD therapy. This likely represents a modifiable barrier to ICD implantation. Structured education for medical trainees on the appropriate use and referral practices consistent with practice guidelines may reduce knowledge gaps and increase appropriate ICD implantation.