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Temporal Trends in Quality of Care Among ICD Recipients: Insights From the NCDR®
Study Questions:
What are temporal trends between 2006 and 2010 in performance on select quality metrics among hospitals participating in the National Cardiovascular Data Registry (NCDR®) implantable cardioverter-defibrillator (ICD) Registry?
Methods:
The authors performed an observational study in which they analyzed data for patients undergoing first-time transvenous ICD implantation, and divided periods of analysis into 12-month intervals from 04/01/2006 to 03/31/2010. The authors assessed performance on the following three quality metrics: adverse events (in-hospital complications or mortality), optimal medical therapy (OMT), and cardiac resynchronization therapy (CRT). Patient characteristics and outcomes were compared among different years.
Results:
In a sample of 367,153 patients, there were significant declines in adverse events over the study period (decreasing from 3.7% to 2.8% overall, trend p < 0.001). The proportion of eligible patients receiving OMT steadily increased from 69.0% to 74.3% in year 4 (p for trend < 0.001). The proportion of eligible patients receiving CRT increased from 80.5% to 84.2% (p for trend < 0.001). There was no correlation between in-hospital adverse events and either CRT or OMT among eligible patients.
Conclusions:
In a large sample of patients from hospitals voluntarily participating in an ICD registry over a 4-year time period, adverse events decreased and rates of OMT and CRT increased.
Perspective:
The current analysis demonstrates improvements in quality of care in patients participating in a voluntary ICD Registry. As the authors acknowledge, there is significant room for continued improvement: In year 4, 26% of eligible patients did not receive OMT, and 16% did not receive CRT. And, while the improvement in quality metrics is encouraging, the factors responsible for this trend remain unknown. Future studies should better elucidate these factors.
Keywords: Hospitals, Registries, Defibrillators, Cardiac Resynchronization Therapy
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