Grant: Master's Award: Canada Graduate Scholarships

Sudden cardiac death is a leading cause of mortality in developed countries. Landmark trials have shown that implantable cardioverter-defibrillators (ICDs) reduce all-cause mortality in patients known arrhythmia for secondary prevention, as well as asymptomatic patients with both ischemic and non-ischemic cardiomyopathy for primary prevention. However, ICD patients in the ""real world"" are often older with a greater burden of comorbidities than those from randomized controlled trials, placing them at higher risk of procedure complications, prolonged hospitalizations, and increased health care costs. Since longevity of ICD devices range from 5 to 10 years, many patients will eventually require replacement procedures. There is a paucity of high-quality evidence on the experiences with long-term ICD therapy in the ""real-world"". To our knowledge this project will be the first to use population-level health administrative data housed within the Ontario ICD database to describe predictors of mortality, ICD replacement, and health care utilization in a 10 year follow-up of adult patients who received de novo ICD therapy for primary prevention in Ontario between February 2007 and February 2011. This database is uniquely equipped for broadly inclusive data collection due to Ontario's single-payer health care system, including variables such as patient factors (socioeconomical status, age, sex), device factors (device type, number of leads), and operator factors (surgeon vs. non-surgeon, physician implantation volume). Identification of modifiable patient and system factors leading to health inequity and increased healthcare utilization will ultimately drive new health policies and guidelines towards improving the care of patients with ICD therapy in Canada.