Abstract 21114: Implantable Cardioverter Defibrillator Usage in the Commonwealth of Massachusetts - A 10 Year Study (1998-2008)
Heart disease is the leading cause of death in both men and women. There has been a rapid increase in internal cardioverter defibrillator (ICD) use for primary and secondary prevention since FDA approval in 1988. We tested the hypothesis that utilization frequency of ICDs differs by sex in the Commonwealth of Massachusetts. We identified ICD implantations as primary prevention (primary diagnosis of heart failure or cardiomyopathy diagnosis during ICD admission) or secondary prevention (history of cardiac arrest or ventricular tachycardia twelve months prior to implant admission and not belonging to primary prevention cohort) using billing codes included in the Massachusetts Inpatient and Outpatient discharge dataset from October 1, 1997 through September 30, 2008. For comparisons between age groups, we obtained five (5) year interval age groups from population estimates by the National Center for Health Statistics and computed rates per 100,000 population. We found that from 1998 to 2008, total annual ICD implants increased by 88.5% in men (542 to 1,019) and increased by 85.8% in women (176 to 327). Men received ICDs by 3 - 8 times more frequently for primary prevention and by 3-9 times more frequently for secondary prevention than women. The ICD rate of 18-36 per 100,000 for men for secondary prevention was similar to that in women for primary prevention. In the > 65 years groups, men received ICDs at 15-25/100,000 compared to women receiving 1-2 per 100,000. Although the primary prevention randomized controlled trials (RCTs) included less than 10% of patients over 75 years, the over 75 year groups received the highest frequency of ICDs in men (130-250 per 100,000) and women (16-33 per 100,000) accounting for 44.5% and 43.5% of the Medicare population respectively. For the Commonwealth of Massachusetts, we conclude that a) men have a disproportionate share of heart disease potentially leading to sudden cardiac death or that women are undertreated for sudden cardiac death and b) that in the Medicare population, ICDs are commonly implanted in age groups where there is little evidence to support their use.
- Implantable cardioconvert defibrillator
- Sudden cardiac death
- Health services research
- © 2010 by American Heart Association, Inc.