Temporal Trends in Quality of Care among ICD Recipients: Insights from the NCDR®
Background—The ICD Registry™ was established in 2006 in part to measure quality of care in patients undergoing ICD implantation; however, whether outcomes have improved since initiation of the registry is unknown. Our objective was to examine changes over time in three quality metrics available from the registry.
Methods and Results—We performed an observational study of 367,153 patients receiving new ICD implants from 4/2006-3/2010. Three quality metrics were selected: adverse events (in-hospital complications or mortality), optimal medical therapy (OMT), and cardiac resynchronization therapy (CRT). OMT was defined as prescription of beta blocker and either ACE inhibitor or ARB in eligible patients. CRT eligibility was determined by QRS ≥120ms, LVEF ≤35%, and NYHA class III/IV. Observation periods were divided into four 12-month intervals. We analyzed changes over time, and used hierarchical logistic regression to adjust for potential confounders. Adverse events decreased over time (3.7% to 2.8%, P<0.001). Among eligible patients, rates of OMT and CRT increased over time (OMT: 69.0% to 74.3%, P <0.001; CRT: 80.5% to 84.2%, P<0.001). After adjustment for potential confounders, patients were significantly less likely to experience adverse events in Year 4 compared with Year 1 (OR 0.75, 95% CI 0.71-0.79), and significantly more likely to receive OMT (OR 1.29, 95% CI 1.26-1.32) and CRT (OR 1.42, 95% CI 1.35-1.49).
Conclusions—Since initiation of the ICD Registry, adverse events are decreasing, and rates of OMT and CRT among eligible patients are increasing, although there is still significant room for improvement.
- Received May 10, 2013.
- Revision received October 10, 2013.
- Accepted October 17, 2013.