NCDR Study: Hospital-Level Variation in Use of CRT-D Associated With Differences in Patient Outcomes
Wide variation in the utilization of CRT-D across hospitals was associated with clinically significant differences in patient outcomes, according to a recent study published in Heart Rhythm.
Philip W. Chui, MD, et al., used data from ACC's EP Device Implant Registry to evaluate 30,134 patients across 1,377 hospitals from 2010 to 2015. They calculated the intraclass correlation coefficient to determine how much patient-level variability in the use of guideline-recommended CRT-D was attributable to the treating hospital and used multilevel modeling to quantify the impact that hospital variation had on outcomes, specifically looking at all-cause mortality, readmissions and cardiac readmissions.
Results confirmed a wide variation in the use of CRT-D across hospitals, with a median rate of CRT-D implantation in patients meeting guideline indications of 89%. After adjustment for patient factors, researchers found that 74% of the variation was due to the hospital in which the patient received treatment. Variation in hospital use of CRT-D was associated with significant differences in the patient outcomes analyzed: 8.76% for hospital mortality, 5.26% for readmissions and 4.71% for cardiac readmissions (p<0.001).
Researchers acknowledge that to determine out-of-hospital mortality and readmission rates, the study linked registry data to Medicare claims data. Therefore, only Medicare beneficiaries aged 65 years or older were included. Additional study limitations include data not captured by the registry, such as other unmeasured but clinically appropriate reasons for forgoing CRT-D implantation or patients who were eligible for an ICD or CRT-D but did not receive any device.
"These findings have significant public health and clinical implications, as it suggests that appropriate CRT-D utilization may be a process metric that effectively reflects the quality of care delivered to patients with heart failure undergoing cardiac device implantations," write the authors.
Keywords: National Cardiovascular Data Registries, EP Device Implant Registry, United States, Medicare, Patient Readmission, Heart Failure, Registries, Cardiac Resynchronization Therapy
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