ACC's ICD Registry enables participating hospitals to track and measure quality improvement and demonstrate commitment to excellent cardiovascular care.

The registry is an important resource for hospitals working to optimize care for patients undergoing ICD implantation or cardiac resynchronization therapy. It provides feedback with national benchmarks on a wide range of quality metrics, including processes of care and patient outcomes, as well as information on patient selection for these procedures.

In addition, the ICD Registry can provide assurance that hospitals are following the Centers for Medicare and Medicaid Services (CMS) national coverage determination (NCD) criteria, providing protection in the event of overuse allegations. A study published last year in the Journal of the American Medical Association found a decrease in the volume and proportion of primary prevention ICD implantations that did not meet CMS NCD criteria at all hospitals in the U.S., with larger declines at hospitals that later settled with the Department of Justice (DOJ) following an investigation into potential overuse of ICDs.

For the study, Nihar R. Desai, MD, MPH, FACC, et al., examined changes in the number of ICD implantations that did not meet NCD criteria after the DOJ investigation was announced in January 2011, both at hospitals that did and did not settle. Using data from the ICD Registry, the researchers identified 309,850 primary prevention ICD implantations for ischemic and nonischemic cardiomyopathy among Medicare beneficiaries between 2007 and 2015.

During the study period, there was a 62.7 percent relative decline and 16.1 percent absolute decline in the proportion of ICDs that did not meet NCD criteria at the hospitals that later settled. In comparison, hospitals that did not settle experienced a 53.2 percent relative decline and a 12.1 percent absolute decline. In addition, the study found hospital-level variations in the percentage of facilities that met NCD criteria. At the top-performing institutions, less than 3.8 percent of ICD implants did not meet NCD criteria, while more than 14.3 percent of ICDs did not meet criteria at the lower-performing hospitals.

"The hospital-level variation may reflect continued room for improvement but may also indicate a gap in the NCD," Desai says. "As current guidelines state, care for a particular patient ultimately falls to the clinician and that patient and thus the guidelines may not fit all patients. The DOJ did acknowledge there are valid clinical indications for placing an ICD outside NCD criteria."

Participation in the ICD Registry may safeguard hospitals from such allegations, allowing them to focus on quality improvement efforts. As the availability of big data and reliance on appropriate use criteria increase, whistleblower complaints similar to the one that led to the DOJ investigation "may be anticipated" in the future, writes Paul A. Heidenreich, MD, MS, FACC, in an editorial that accompanied the study. "Physicians and hospitals can lead … by developing appropriate use criteria and participating in registries tracking appropriate use," Heidenreich concludes.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Quality Improvement, National Cardiovascular Data Registries, Quality Summit, Cardiac Resynchronization Therapy, Centers for Medicare and Medicaid Services, U.S., Patient Selection, Benchmarking, Quality Improvement, Medicare, Medicaid, Defibrillators, Implantable, Primary Prevention, Registries, Cardiomyopathies, ICD Registry

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