Recent Trends in Utilization of Implantable Cardioverter-Defibrillators in Survivors of Cardiac Arrest in the United States

Background: Cardiac arrest (CA) is a class I indication for implantable defibrillator (ICD) therapy. We studied the trend of ICD utilization in survivors of CA in the US population between 2002 and 2006.
Methods: We searched the National Hospital Discharge Survey for patients admitted with the primary diagnosis of CA who survived to hospital discharge. Patients with a concomitant diagnosis of acute myocardial infarction or previous ICD implantation were excluded.
Results: From 2002 to 2006, 758 patients were surveyed representing 88,920 discharges. Of those, 396 (52.2%) representing 48,098 discharges did not survive to hospital discharge. Of the remaining 362 (representing 38,855) patients, 38.4% received an ICD prior to discharge. Independent predictors of in-hospital mortality included older age, female gender, black race, smaller hospital of discharge, and a higher number of organ failures (P < 0.001 for all). Using logistic regression, patients who were discharged with an ICD were more likely to have been discharged from a larger hospital (odds ratio = 2.35 for each additional 100 beds, P < 0.001) and to be less sick (odds ratio = 0.85 for each additional organ failure, P < 0.001). There was no gender or racial discrepancy in the ICD utilization after CA.
Conclusions: Despite their class I indication after CA, ICDs continue to be underutilized, but the previously documented racial gaps have disappeared. Our data reveal a large discrepancy in ICD utilization by the size of the discharge hospital, which may suggest regional influences and gaps in resource allocations. Future studies looking into the root causes of these discrepancies and possible remedies are warranted.     

Chelation in Metal Intoxication XXXVIII: Effect of Structurally Different Chelating Agents in Treatment of Nickel Intoxication in Rat

Some structurally different chelating agents viz. -mercapto-ß-(2-furyl)acrylic acid (MFA), -mercapto-ß-(2-thienyl) acrylicacid (MTA), meso 2,3-dimercaptosuccinic acid (DMSA), 2,3-dimercap-topropane-1-sulfonate(DMPS), diethyl dithiocarbamate (DE-DTC), and N-benzyl-D-glucaminedithiocarbamate (NBG-DTC) were evaluated for their efficacyto mobilize nickel and reverse some nickel-induced biochemicalalterations in experimental nickel intoxication. MFA, DMSA,and NBG-DTC appear more effective than their corresponding homologs,MTA, DMPS and DE-DTC, respectively, in enhancing urinary andfecal excretion of nickel and lowering tissue burden of nickelin nickel preexposed rats. These, particularly NBG-DTC, appearpromising in the treatment of nickel (II) poisoning. However,there seems no definite relationship between the structure ofthe chelating agents examined and their ability to counteractthe effects of nickel.