Abstract 20649: Optimal Medical Therapy Use Among Implantable Cardioverter-Defibrillator Recipients: Insights from the NCDR ICD Registry
Background: Current guideline recommendations for implantable cardioverter-defibrillators (ICD) in patients with left ventricular systolic dysfunction presuppose that such patients are receiving optimal medical therapy (OMT). However, little is known about the extent to which patients undergoing ICD implantation are receiving OMT and the patient and provider factors associated with low OMT use in ICD patients.
Methods: We examined OMT (defined as both beta blocker and angiotensin converting enzyme inhibitor [ACEI]/angiotensin II receptor blocker [ARB]) at discharge among patients with EF<35% receiving an ICD (primary or secondary prevention, new implant or device revision/generator change) in the NCDR ICD Registry from 1/1/2007 to 6/30/2009. A multivariable logistic regression model was constructed to identify independent factors associated with OMT.
Results: Of the 231,725 patient stays included in the analysis, 63.1%, 16.6%, and 87.8% received an ACEI, ARB, and beta blocker, respectively, with 73.1% of patients receiving OMT at discharge. Patients with hypertension, PCI during the admission, and who received their ICD at a teaching hospital were most likely to receive OMT. Patients least likely to receive OMT were those whose care was primarily directed by a surgeon (CABG during the admission and/or implanting provider was board certified in surgery), with odds ratios of 0.69 and 0.77, respectively. Patients with a prior ICD were also less likely to receive OMT (odds ratio 0.82). Race was not predictive of OMT use.
Conclusions: Despite guideline recommendations, more than one quarter of ICD recipients are not medically optimized at the time of ICD implantation. These results highlight patient and provider characteristics that may be targets of quality improvement efforts to minimize gaps in heart failure care.
- © 2010 by American Heart Association, Inc.