Abstract 15534: How Overall Health Status and Insurance Influence Utilization of the Primary Prevention Implantable Defibrillator in the Current Era
Introduction: The benefit of the implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death in selected patients with left ventricular dysfunction is well established. However, several studies have reported that not all eligible patients receive this therapy.
Hypothesis: We hypothesized that co-morbid health conditions and nature of health insurance play a role in the utilization patterns of the primary prevention ICD.
Methods: Patients eligible for PPICD based on current guidelines were analyzed from the electronic medical records of a large US tertiary care center. Demographic and clinical data as well as insurance status were reviewed in detail for ICD recipients before implantation compared to ICD non-recipients. The Charlson Comorbidity Index (CCI) was calculated and categorized as low(0-1), medium(2-6) and high(7-12).
Results: Over an 8-month period, comparisons were made between 110 recipients and 110 non-recipients. ICD recipients were younger (62.1±15.0 vs. 68.0±18.2; P=0.009), with higher proportion of males (80% vs. 65.5%; P=0.01), and higher BMI (27.8±7.7 vs. 24.3±6.9; P=0.001). Compared to ICD non-recipients, ICD recipients were more likely to have lower comorbidities (high CCI 5.5 % vs. 11.8%; P=0.05) and lower LVEF (23.8±6.4 vs. 25.3±7.2; P=0.04). ICD recipients were less likely to be current alcohol users (5.5% vs. 8.2%; P=0.05), smokers (5.5% vs. 13.6%, P=0.03) or have history of drug abuse (0.9% vs. 5.5%; P=0.02). ICD recipients were more likely to have combined public and private insurance (29.1% vs. 18.2%, P=0.03), and less likely to have public insurance alone (28.2% vs. 32.7%, P=0.05). In multivariable model, independent predictors of implantation included male sex (OR 2.23[1.15-4.33]; P=0.02), age<75 (OR 2.54[1.35-4.78]; p=0.004), having combined public and private health insurance (OR 2.16[1.01-4.68]; P=0.05), non-smoker status (OR 3.70[1.29-10.57]; P=0.01), and lower CCI (OR 3.47[1.17-10.31]; P=0.02).
Conclusions: Our findings suggest that age, sex and co-morbid conditions continue to determine ICD utilization in real world clinical practice, with insurance status also playing a role. This important area warrants significant further investigation in diverse US communities.
Author Disclosures: L. Zhang: None. K. Narayanan: None. H. Chugh: None. S. Takahiro: None. Z. Zheng: None. S.S. Chugh: Research Grant; Significant; NHLBI (R01 HL105170, R01 HL088416).
- © 2014 by American Heart Association, Inc.