Implantable cardioverter-defibrillator use among medicare patients with low ejection fraction after acute myocardial infarction

Sean D. Pokorney, Amy L. Miller, Anita Y. Chen, Laine Thomas, Gregg C. Fonarow, James A de Lemos, Sana M. Al-Khatib, Eric D. Peterson, Tracy Y. Wang

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2433-2440
Number of pages8
JournalJAMA - Journal of the American Medical Association
Volume313
Issue number24
DOIs
StatePublished - Jun 23 2015

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Implantable Defibrillators
Medicare
Myocardial Infarction
Mortality
Patient Transfer
Troponin
Cardiogenic Shock
Cardiology
Coronary Artery Bypass
Observational Studies
Registries

ASJC Scopus subject areas

  • Medicine(all)

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Implantable cardioverter-defibrillator use among medicare patients with low ejection fraction after acute myocardial infarction. / Pokorney, Sean D.; Miller, Amy L.; Chen, Anita Y.; Thomas, Laine; Fonarow, Gregg C.; de Lemos, James A; Al-Khatib, Sana M.; Peterson, Eric D.; Wang, Tracy Y.

In: JAMA - Journal of the American Medical Association, Vol. 313, No. 24, 23.06.2015, p. 2433-2440.

Research output: Contribution to journalArticle

Pokorney, Sean D. ; Miller, Amy L. ; Chen, Anita Y. ; Thomas, Laine ; Fonarow, Gregg C. ; de Lemos, James A ; Al-Khatib, Sana M. ; Peterson, Eric D. ; Wang, Tracy Y. / Implantable cardioverter-defibrillator use among medicare patients with low ejection fraction after acute myocardial infarction. In: JAMA - Journal of the American Medical Association. 2015 ; Vol. 313, No. 24. pp. 2433-2440.
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abstract = "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.",
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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.

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