Abstract 15314: Do ICD Implants for Primary Prevention (PP) Meet Center for Medicare Services (CMS) Guidelines? : The Wake Forest Baptist Medical Center (WFBMC) Experience
Background: ICD therapy is effective in reducing mortality in patients (Pts) with cardiomyopathy (CM) with reduced ejection fraction (EF) <35%. However, the benefit of ICD therapy is unclear in pts who had recent myocardial infarction (MI), coronary revascularization (PCI), congestive heart failure (CHF), coronary artery bypass graft (CABG), and New York Heart Association (NYHA) class IV CHF. We sought to determine whether ICDs implanted at WFBMC meet CMS guidelines.
Methods: The National Cardiovascular Data Registry (NCDR) was queried to identify patients with CM who underwent ICD implant for PP between 10/1/07 - 3/31/10. We searched NCDR using terms “PP”, “new device”, and “WFBMC”. ICDs were classified as non-guidelines supported if they were implanted within 40 days of MI, had a new diagnosis of CHF within 3 months, had PCI or CABG within 90 days or if they had NYHA class IV CHF.
Results: After our initial query, 276 devices were implanted during this period for PP. We identified 62 cases that seemingly did not meet CMS guidelines (Recent MI: 19 pts, New CHF: 20 pts, NYHA IV CHF: 11 pts, Recent PCI or CABG: 12 pts). Upon review of medical records, 39 (63%) of the 62 pts were incorrectly coded as having MI, PCI, CABG or Class IV CHF while another 20 (32%) had compelling clinical indications for ICD implantation. Only 3 (5%) of the pts did not meet guidelines for ICD implantations which represents ~1% of total ICD implants (Table 1).
Conclusions: This study demonstrates that at WFBMC, the majority of ICDs implants are in accordance with CMS guidelines. It also suggests that guidelines are no replacement for clinical decision making and that registries are limited by the quality of data entry. We propose more education and better training for accurate data entry and maintenance of registry.
- © 2011 by American Heart Association, Inc.