Non-evidence-based ICD implantations in the United States

Sana M. Al-Khatib, Anne Hellkamp, Jeptha Curtis, Daniel Mark, Eric Peterson, Gillian D. Sanders, Paul A. Heidenreich, Adrian F. Hernandez, Lesley H. Curtis, Stephen Hammill

Research output: Contribution to journalArticlepeer-review

Abstract

Context: Practice guidelines do not recommend use of an implantable cardioverter-defibrillator (ICD) for primary prevention in patients recovering from a myocardial infarction or coronary artery bypass graft surgery and those with severe heart failure symptoms or a recent diagnosis of heart failure. Objective: To determine the number, characteristics, and in-hospital outcomes of patients who receive a non-evidence-based ICD and examine the distribution of these implants by site, physician specialty, and year of procedure. Design, Setting, and Patients: Retrospective cohort study of cases submitted to the National Cardiovascular Data Registry-ICD Registry between January 1, 2006, and June 30, 2009. Main Outcome Measure: In-hospital outcomes. Results: Of 111 707 patients, 25 145 received non-evidence-based ICD implants (22.5%). Patients who received a non-evidence-based ICD compared with those who received an evidence-based ICD had a significantly higher risk of in-hospital death (0.57% [95% confidence interval {CI}, 0.48%-0.66%] vs 0.18% [95% CI, 0.15%-0.20%]; P<.001) and any postprocedure complication (3.23% [95% CI, 3.01%-3.45%] vs 2.41% [95% CI, 2.31%-2.51%]; P<.001). There was substantial variation in non-evidence-based ICDs by site. The rate of non-evidence-based ICD implants was significantly lower for electrophysiologists (20.8%; 95% CI, 20.5%-21.1%) than nonelectrophysiologists (24.8% [95% CI, 24.2%-25.3%] for nonelectrophysiologist cardiologists; 36.1% [95% CI, 34.3%-38.0%] for thoracic surgeons; and 24.9% [95% CI, 23.8%-25.9%] for other specialties) (P<.001 for all comparisons). There was no clear decrease in the rate of non-evidence-based ICDs over time (24.5% [6908/28 233] in 2006, 21.8% [7395/33 965] in 2007, 22.0% [7245/32 960] in 2008, and 21.7% [3597/16 549] in 2009; P<.001 for trend from 2006-2009 and P=.94 for trend from 2007-2009). Conclusion: Among patients with ICD implants in this registry, 22.5% did not meet evidence-based criteria for implantation.

Original languageEnglish (US)
Pages (from-to)43-49
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume305
Issue number1
DOIs
StatePublished - Jan 5 2011
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)

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