NCDR Study Shows Decline in ICD Mortality, Rehospitalization and Device-Related Complications

Assessing temporal trends in patient characteristics and outcomes of a very large population of elderly patients undergoing primary prevention implantable cardioverter-defibrillators (ICD) implantation, new research has revealed that while the characteristics of patients selected for the therapy have largely been unchanged, there are significant improvements in mid-term outcomes, including mortality, rehospitalization, and device-related complication, suggesting meaningful advances in the care of this demographic.

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Led by Ryan Borne, MD, University of Colorado Anschutz Medical Campus, Aurora, CO, and published August 5 in Circulation, the investigation analyzed data from the ICD Registry, including Medicare fee-for-service beneficiaries aged 65 years and older with left ventricular ejection fraction, less than 35 percent who underwent primary prevention ICD implantation between 2006 and 2010 and could be matched to Medicare claims. With the total cohort including 117,100 patients, only modest changes in patient characteristics were noted. Data showed that fewer single lead devices and cardiac resynchronization therapy devices were used over time, and that there were significant declines in all outcomes, including six-month all-cause mortality (7.1 percent in 2006, 6.5 percent 2010; adjusted OR 0.88; 95 percent CI 0.82-0.95), six-month rehospitalization (36.3 percent in 2006, 33.7 percent in 2010; OR 0.87; 95 percent CI 0.83-0.91) and device-related complications (5.8 percent in 2006, 4.8 percent in 2010; OR 0.80; 95 percent CI 0.74-0.88).

The authors conclude that, "there have been relatively modest changes in the clinical characteristics of patients receiving ICDs between 2006 and 2010, suggesting a consistent approach to patient selection." Further, the temporal trends observed "suggest meaningful improvements in the care of this patient population."

According to an editorial comment by Andrea Russo, MD, FACC, director, Electrophysiology and Arrhythmia Services, Cooper University Hospital, these trends are promising and suggest improvements in care "despite use of device therapy in elderly patients with greater comorbidities than previously described in clinical trials." She adds that "although this study cannot identify the reasons for these improvements, it is hypothesis generating and highlights the value of the ICD Registry in identifying outcomes of patients receiving ICDs outside of clinical trials or where 'gaps' in guidelines might exist. In an era of a growing elderly population and limited health care resources, focus on decisions to implant ICDs in elderly patients is inevitable... On-going surveillance of ICD-related outcomes in clinical practice, focusing on subgroups of patients who may not have been well represented in clinical trials, should continue."

Keywords: Electrophysiology, Registries, Hospitals, University, Cardiac Resynchronization Therapy Devices, Fee-for-Service Plans, Demography, Comorbidity, Stroke Volume, Medicare, Defibrillators, Implantable, Primary Prevention, National Cardiovascular Data Registries, ICD Registry

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