Abstract 14672: Trends in Utilization of Cardiac Resynchronization Therapy and Gender Differences in the US - Results from the Nationwide Inpatient Sample 2002-2009
The use of cardiac resynchronization therapy (CRT) has steadily increased after its approval for use in advanced heart failure in 2001 (Figure). However, trends in utilization of CRT have not been characterized. We used the Nationwide Inpatient Sample (NIS) database (the largest all-payer, inpatient database in the US) to identify all patients who had a CRT implantation during 2002-2009, and analyzed the trends of CRT implantation in the US. The patient characteristics, charges and outcomes were examined in detail for each year. The 2009 data were then examined in detail to determine the predictors of higher cost of this therapy. Appropriate survey commands were used for univariate and multivariate analysis. During 2002-2009, there were a total of 320,447 CRT implantations recorded in the NIS database. Gender and racial disparities favoring men (71.6%) and Caucasians (76.4%), respectively, showed nonsignificant changes over the years. The highest number of CRTs were implanted in the 65-84-yr age group (64.9%), with significant increase in number of CRTs implanted in older patients >85 yrs (P=0.02) (Figure). The in-hospital mortality decreased from 1.07% in 2002 to 0.76% in 2009 (Figure). The predictors of higher mortality included males compared with females (0.89% vs. 0.70%, P=0.04), higher age groups (age >85 yr had 1.7% mortality vs. 0.7% for age females), higher comorbidities, payer type (Medicaid>private insurance>Medicare). We conclude that gender and racial disparities exist in CRT resource utilization. We also identify predictors of outcomes and charges for CRTs. Future studies will be necessary to better understand the limitations in equitable distribution and the cost effectiveness of CRTs.
- © 2012 by American Heart Association, Inc.