Appropriateness of Internal Cardioverter-Defibrillator Device Implants in the United States.
American College of Cardiology
National Cardiovascular Data Registry
appropriateness
cardiac resynchronization therapy
internal cardioverter defibrillator
outcomes
primary prevention
secondary prevention
sudden cardiac death
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
18 Dec 2023
18 Dec 2023
Historique:
received:
17
09
2023
revised:
12
12
2023
accepted:
13
12
2023
medline:
21
12
2023
pubmed:
21
12
2023
entrez:
20
12
2023
Statut:
aheadofprint
Résumé
The appropriate use criteria (AUC) are a diverse group of indications aimed to better evaluate the benefits of ICD and CRT therapy. To quantify the proportion of ICD and CRT-D implants as appropriate, maybe appropriate (MA), or rarely appropriate (RA) based on AUC guidelines. Multicenter, retrospective study of patients within the NCDR undergoing ICD implant between April 2018, and March 2019, at >1500 U.S. hospitals. The appropriateness of ICD implants was adjudicated using the AUC. Of 309,318 ICDs, 241,438 (78.1%) were primary and 67,880 (21.9%) secondary prevention implants; 80% were mappable to the AUC. For primary prevention, 185,431 ICDs (96.4%) were appropriate, 5,660 (2.9%) MA, and 1,205 (0.6%) RA. For secondary prevention, 47,498 ICDs (92.7%) were appropriate, 2,581 (5%) MA, and 1,157 (2.3%) RA. Significant number of RA implants occurred in NYHA class IV HF patients, ineligible for advanced therapies (53.9%) and those with MI within 40 days (18.1%). The appropriateness of pacing lead was more variable, with 48,470 (62%) of dual chamber ICD implants being classified as appropriate, 29,209 (37.4%) MA and 448 (0.6%) RA. Amongst CRT-D implants, 63,848 (82.2%) were appropriate, 9,900 (12.7%) MA and 3,940 (5.1%) RA for LV pacing. 99,754 implants were deemed appropriate but excluded from CMS' national coverage determination (NCD). Over 92% of hospitals <4% RA implant rate. In this large national registry, 95% of mappable ICD and CRT-D implants were considered appropriate with <2% of rarely appropriate implants. Nearly 100,000 appropriate implants are excluded by CMS' NCD.
Sections du résumé
BACKGROUND
BACKGROUND
The appropriate use criteria (AUC) are a diverse group of indications aimed to better evaluate the benefits of ICD and CRT therapy.
OBJECTIVE
OBJECTIVE
To quantify the proportion of ICD and CRT-D implants as appropriate, maybe appropriate (MA), or rarely appropriate (RA) based on AUC guidelines.
METHODS
METHODS
Multicenter, retrospective study of patients within the NCDR undergoing ICD implant between April 2018, and March 2019, at >1500 U.S. hospitals. The appropriateness of ICD implants was adjudicated using the AUC.
RESULTS
RESULTS
Of 309,318 ICDs, 241,438 (78.1%) were primary and 67,880 (21.9%) secondary prevention implants; 80% were mappable to the AUC. For primary prevention, 185,431 ICDs (96.4%) were appropriate, 5,660 (2.9%) MA, and 1,205 (0.6%) RA. For secondary prevention, 47,498 ICDs (92.7%) were appropriate, 2,581 (5%) MA, and 1,157 (2.3%) RA. Significant number of RA implants occurred in NYHA class IV HF patients, ineligible for advanced therapies (53.9%) and those with MI within 40 days (18.1%). The appropriateness of pacing lead was more variable, with 48,470 (62%) of dual chamber ICD implants being classified as appropriate, 29,209 (37.4%) MA and 448 (0.6%) RA. Amongst CRT-D implants, 63,848 (82.2%) were appropriate, 9,900 (12.7%) MA and 3,940 (5.1%) RA for LV pacing. 99,754 implants were deemed appropriate but excluded from CMS' national coverage determination (NCD). Over 92% of hospitals <4% RA implant rate.
CONCLUSION
CONCLUSIONS
In this large national registry, 95% of mappable ICD and CRT-D implants were considered appropriate with <2% of rarely appropriate implants. Nearly 100,000 appropriate implants are excluded by CMS' NCD.
Identifiants
pubmed: 38123044
pii: S1547-5271(23)03001-1
doi: 10.1016/j.hrthm.2023.12.005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023. Published by Elsevier Inc.