TY - JOUR
T1 - Implantable cardioverter-defibrillator use among medicare patients with low ejection fraction after acute myocardial infarction
AU - Pokorney, Sean D.
AU - Miller, Amy L.
AU - Chen, Anita Y.
AU - Thomas, Laine
AU - Fonarow, Gregg C.
AU - de Lemos, James A
AU - Al-Khatib, Sana M.
AU - Peterson, Eric D.
AU - Wang, Tracy Y.
N1 - Publisher Copyright:
Copyright 2015 American Medical Association. All rights reserved.
PY - 2015/6/23
Y1 - 2015/6/23
N2 - IMPORTANCE: Implantable cardioverter-defibrillators (ICDs) are not recommended within 40 days of myocardial infarction (MI); thus, ICD implantation might not be considered during the post-MI care transition. OBJECTIVE: To examine ICD implantation rates and associated mortality among older MI patients with low ejection fraction (EF). DESIGN, SETTING, AND PARTICIPANTS: Retrospective observational study of Medicare beneficiaries with an EF of 35% or less after MI, treated at 441 US hospitals between 2007 and 2010, excluding patients with prior ICD implantation. Follow-up data were available through December 2010. EXPOSURES: ICD implantation within 1 year of MI vs no ICD implantation within 1 year of MI. MAIN OUTCOMES AND MEASURES: Patient characteristics associated with receiving an ICD within 1 year after discharge and 2-year mortality associated with ICD implantation. RESULTS: Among 10 318 MI patients with EF of 35% or lower, the cumulative 1-year ICD implantation rate was 8.1% (95% CI, 7.6%-8.7%). Patients with ICD implantation were more likely to have prior coronary artery bypass graft procedures, higher peak troponin levels, in-hospital cardiogenic shock, and cardiology follow-up within 2 weeks after discharge relative to patients who did not receive an ICD within 1 year. Implantation of ICD was associated with lower 2-year mortality (15.3 events per 100 patient-years [128 deaths in 838 patient-years] vs 26.4 events per 100 patient-years [3033 deaths in 11 479 patient-years]; adjusted HR, 0.64; 95% CI, 0.53-0.78). (Table Presented) CONCLUSIONS AND RELEVANCE: In this large registry study of older patients who experienced MI from 2007-2010, fewer than 1 in 10 eligible patients with low EF received an ICD within 1 year after MI, although ICD implantation was associated with lower risk-adjusted mortality at 2 years. Additional research is needed to determine evidence-based approaches to increase ICD implantation among eligible patients.
AB - IMPORTANCE: Implantable cardioverter-defibrillators (ICDs) are not recommended within 40 days of myocardial infarction (MI); thus, ICD implantation might not be considered during the post-MI care transition. OBJECTIVE: To examine ICD implantation rates and associated mortality among older MI patients with low ejection fraction (EF). DESIGN, SETTING, AND PARTICIPANTS: Retrospective observational study of Medicare beneficiaries with an EF of 35% or less after MI, treated at 441 US hospitals between 2007 and 2010, excluding patients with prior ICD implantation. Follow-up data were available through December 2010. EXPOSURES: ICD implantation within 1 year of MI vs no ICD implantation within 1 year of MI. MAIN OUTCOMES AND MEASURES: Patient characteristics associated with receiving an ICD within 1 year after discharge and 2-year mortality associated with ICD implantation. RESULTS: Among 10 318 MI patients with EF of 35% or lower, the cumulative 1-year ICD implantation rate was 8.1% (95% CI, 7.6%-8.7%). Patients with ICD implantation were more likely to have prior coronary artery bypass graft procedures, higher peak troponin levels, in-hospital cardiogenic shock, and cardiology follow-up within 2 weeks after discharge relative to patients who did not receive an ICD within 1 year. Implantation of ICD was associated with lower 2-year mortality (15.3 events per 100 patient-years [128 deaths in 838 patient-years] vs 26.4 events per 100 patient-years [3033 deaths in 11 479 patient-years]; adjusted HR, 0.64; 95% CI, 0.53-0.78). (Table Presented) CONCLUSIONS AND RELEVANCE: In this large registry study of older patients who experienced MI from 2007-2010, fewer than 1 in 10 eligible patients with low EF received an ICD within 1 year after MI, although ICD implantation was associated with lower risk-adjusted mortality at 2 years. Additional research is needed to determine evidence-based approaches to increase ICD implantation among eligible patients.
UR - http://www.scopus.com/inward/record.url?scp=84937597763&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84937597763&partnerID=8YFLogxK
U2 - 10.1001/jama.2015.6409
DO - 10.1001/jama.2015.6409
M3 - Article
C2 - 26103027
AN - SCOPUS:84937597763
SN - 0098-7484
VL - 313
SP - 2433
EP - 2440
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
IS - 24
ER -