While there has been a significant improvement in the quality of care of patients receiving implantable cardioverter-defibrillators (ICD), there still remains "significant room for improvement," according to a study published Nov. 5 in Circulation.

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The study looked at 367,153 patients enrolled in the ICD Registry who received new ICD implants from April 2006 – the start of the registry – through March 2010. Results showed adverse events – including in-hospital complications or mortality – decreased over time (3.7 percent to 2.8 percent, P<0.001), and among eligible patients receiving optimal medical therapy (OMT) and cardiac resynchronization therapy (CRT), rates of OMT and CRT increased over time (69.0 percent to 74.3 percent, P<0.001, and 80.5 percent to 84.2 percent, P<0.001, respectively).

Further, after adjusting for cofounders, the authors found that patients were less likely to experience adverse events at the end of the study period, as compared to the start, and more likely to receive OMT and CRT. However, at the end of the study period, 26 percent of eligible patients did not receive OMT, and 16 percent did not receive CRT. The authors also found that "many hospitals had worse outcomes" in the end of the study period compared to the start of the study period.

The authors conclude that "while [the improvements in quality of care] trends are encouraging, there remains significant variation among hospitals, highlighting the importance of continued quality improvement efforts." They add that moving forward, "determining factors that promote improvements in quality of care is an important avenue of further research."

Keywords: Quality Improvement, Registries, Cardiac Pacing, Artificial, Defibrillators, Implantable, Cardiac Resynchronization Therapy

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