Abstract 1064: Factors Influencing the Use of Higher-Tech/Higher Cost Implantable Cardioverter-Defibrillators: Data From the NCDR ICD Registry
Introduction: New ICD models are regularly introduced, incorporating technological advantages. The factors associated with use of these higher-tech/higher cost devices as opposed to older models have not been identified.
Methods: We analyzed the 84,321 cases receiving a new ICD implants submitted by 981 hospitals to the NCDR ICD Registry between 6/05 and 7/07. Devices were categorized as “outmoded” 3 months after a new model from the same manufacturer was released, based on date of implant. A non-parsimonious model including all demographic, clinical, provider, and hospital characteristics was created using logistic regression to predict use of an “outmoded” device.
Results: Overall 35% of implants involved “outmoded” devices during this timeframe. Use of outmoded devices was greatest in single-chamber (44%), followed by dual-chamber (34%) and biventricular implants (29%) (p<0.0001). However, no demographic (race, gender, payor status), clinical, or provider characteristics had a meaningful impact on use of “outmoded” devices. The model ROC C-statistic was 0.597, implying very limited value of measured characteristics in predicting use of outmoded devices. However, individual hospitals varied greatly in usage of outmoded devices, from 2% in the bottom 100 hospitals, to over 80% in the top.
Conclusion: The use of outmoded devices is influenced only minimally by patient or even provider characteristics. Rather, the main determinant of whether patients received this beneficial modality appears to be the practice patterns at individual hospitals, which may be affected by cost, implanting physician preference, and other factors.