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However, limited data exist on the global trends of implantable cardioverter defibrillator (ICD) utilization and its impact on mortality\/morbidity burden reduction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>Electronic databases were systematically searched up to March 2024 for studies reporting on ICD utilization rates in hypertrophic cardiomyopathy. A random effects model was used to pool study estimates across time-era, geographic region, and age group. Primary outcome was global trends in ICD utilization. Secondary outcomes included trends of sudden cardiac death, appropriate\/inappropriate shocks, and ICD-related complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              In total, 234 studies (N=92\u2005500, 514\u2005748 patient-years) met inclusion criteria. Mean age was 46.2 (12.4) years and 37.49% were women. A total of 12\u2005139 patients (16.43%) received an ICD over 429\u2005766 person-years of follow-up, with an ICD implantation rate of 2.79%\/y ([95% CI, 2.35%\u20133.32%] I\u00b2=97.80%). Rates of ICD implantation steadily increased over time from 1990 (1.09%) to 2021 (4.01%;\n              <jats:italic>P<\/jats:italic>\n              =0.002), with noticeable geographic variation (\n              <jats:italic>P<\/jats:italic>\n              =0.008). The overall rate of appropriate ICD discharges and ICD-related complications was 3.44%\/y ([95% CI, 3.08%\u20133.84%] I\u00b2=88.40%) and 1.98%\/y ([95% CI, 1.52%\u20132.59%] I\u00b2=90.44%), respectively, with no significant trend over time. The overall rate of inappropriate discharges was 3.58%\/y ([95% CI, 3.08%\u20134.16%] I\n              <jats:sup>2<\/jats:sup>\n              =88.03%), and declined significantly over time (\n              <jats:italic>P<\/jats:italic>\n              =0.044). There was a significant decline in the rates of sudden cardiac death from 1990 (0.84%\/y) to 2020 (0.31%\/y).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Dramatic increases in ICD utilization have occurred, representing a 3.7-fold increase, with appropriate therapies occurring in 3.44%\/y. In parallel a significant reduction in sudden cardiac death was observed, but there are insufficient data to demonstrate that a causative relationship exists. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy. Geographic disparities in ICD utilization were evident, highlighting the need to improve access to specialized care for patients with hypertrophic cardiomyopathy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.crd.york.ac.uk\/PROSPERO\/\">https:\/\/www.crd.york.ac.uk\/PROSPERO\/<\/jats:ext-link>\n              ; Unique identifier: CRD42023407126\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circep.124.013479","type":"journal-article","created":{"date-parts":[[2025,2,3]],"date-time":"2025-02-03T10:00:18Z","timestamp":1738576818000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Global and Temporal Trends in Utilization and Outcomes of Implantable Cardioverter Defibrillators in Hypertrophic Cardiomyopathy"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8025-9212","authenticated-orcid":true,"given":"Omar M.","family":"Abdelfattah","sequence":"first","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center, Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (O.M.A., D.A.J., A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-8917","authenticated-orcid":true,"given":"Ahmed","family":"Sayed","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Houston Methodist DeBakey Heart &amp; Vascular Center, Houston Methodist Hospital, TX (A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4754-5440","authenticated-orcid":true,"given":"Ahmed","family":"Al-Jwaid","sequence":"additional","affiliation":[{"name":"Department of Medicine (A.A.-J.), Morristown Medical Center, Atlantic Health System, Morristown, NJ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3423-524X","authenticated-orcid":true,"given":"Ahmed","family":"Hassan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics, The Labatt Family Heart Center, Hospital for Sick Children &amp; University of Toronto, Ontario, Canada (A.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deaa","family":"Abu Jazar","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center, Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (O.M.A., D.A.J., A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3325-8928","authenticated-orcid":true,"given":"Arun","family":"Narayanan","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center, Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston (O.M.A., D.A.J., A.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5277-9296","authenticated-orcid":true,"given":"Mark S.","family":"Link","sequence":"additional","affiliation":[{"name":"Hypertrophic Cardiomyopathy Center, Gagnon Cardiovascular Institute, Department of Cardiovascular Medicine (M.S.L.), Morristown Medical Center, Atlantic Health System, Morristown, NJ."},{"name":"Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (M.S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9255-4657","authenticated-orcid":true,"given":"Matthew W.","family":"Martinez","sequence":"additional","affiliation":[{"name":"Center of Hypertrophic Cardiomyopathy and Sports Cardiology (M.W.M.), Morristown Medical Center, Atlantic Health System, Morristown, NJ."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.11.021"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1710575"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2022.07.012"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2023.04.056"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/pace.12878"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehad194"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2024.02.014"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.15.2008"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0006-341x.2000.00455.x"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1316"},{"key":"e_1_3_3_14_2","unstructured":"Higgins JPT Thomas J Chandler J Cumpston M Li T Page MJ. 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