Patients undergoing implantable cardioverter defibrillator implantation were more likely to receive a device made by the manufacturer that provided the highest total payment to the physician performing the procedure, according to a study published Nov. 3 in the Journal of the American Medical Association. However, researchers noted "no consistent differences were observed for risk of in-hospital complications or death."

In the retrospective study, Amarnath R. Annapureddy, MD, et al., used data from ACC's ICD Registry linked with publicly available payment data from the Open Payment Program to look at the association between payments from four device manufacturers to physicians and device selection among patients undergoing ICD implantation for the first time between January 2016 and December 2018. The researchers also looked at whether quality of care varied among physicians based on whether they received payments from manufacturers.

The study cohort contained 145,900 patients who underwent ICD implantation for the first time by 4,435 physicians at 1,763 facilities. The majority of these procedures were performed by physicians who received payments (94%). Among physicians who received payments, 12% received less than $100; 33% received between $100 and less than $1,000; 43% received between $1,000 and less than $10,000; while 12% received higher than $10,000 total payment per year, respectively. In addition, most physicians received payments from three or four manufacturers. According to the researchers, physicians who received payments were more likely to implant devices from manufacturers that provided the highest payments.

In looking at secondary quality of care outcomes, the authors found that overall, "there was no consistent relationship observed with physician payment." Unadjusted rates of procedural complications or death did not change based on the presence or amount of payments, while there were "statistically significant" differences in use of CRT-D and small differences in use of guideline-recommended medications.

The researchers conclude that a large proportion of ICD implantations are performed by physicians who receive payments from device manufacturers, and there is an association between payments from specific manufacturers and likelihood of using an ICD from that manufacturer. However, they caution that these findings reflect an association but not causation between industry payments and device selection. They also highlight that factors guiding device selection "have not been well characterized but are likely complex, including patient, device, hospital, and physician considerations."

"These findings should be interpreted in the context of two important considerations," said Frederick A. Masoudi, MD, MSPH, FACC, chair of ACC's NCDR Oversight Committee. "First, because the study is cross-sectional and observational, it cannot demonstrate a causal relationship between industry payments and device selection. Second, neither in-hospital outcomes nor quality of care varied among the groups of physicians and performance on metrics of quality were uniformly quite high."

Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Cross-Sectional Studies, Retrospective Studies, Benchmarking, Defibrillators, Implantable, Physicians, Industry, Registries, National Cardiovascular Data Registries, ICD Registry

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