Temporal Trends in Patient Characteristics and Outcomes Among Medicare Beneficiaries Undergoing Primary Prevention Implantable Cardioverter-Defibrillator Placement in the United States, 2006-2010: Results from the NCDR® ICD Registry
Background—Contemporary patterns of use and outcomes of implantable cardioverter-defibrillators (ICDs) in community practice settings are not well characterized. We assessed temporal trends in patient characteristics and outcomes among older patients undergoing primary prevention ICD therapy in US hospitals between 2006 and 2010.
Methods and Results—Using the NCDR ICD Registry, we included Medicare fee-for-service beneficiaries aged 65 years and older with left ventricular ejection fraction ≤ 35% who underwent primary prevention ICD implantation, including those receiving concomitant CRT-D, between 2006 and 2010 and could be matched to Medicare claims. Outcomes were mortality and hospitalization (all-cause and heart failure) at 180 days, and device related complications. Multivariable hierarchical logistic regression was employed to assess temporal trends in outcomes accounting for changes in patient, physician, and hospital characteristics. The cohort included 117,100 patients. Between 2006 and 2010, only modest changes in patient characteristics were noted. Fewer single lead devices and more CRT devices were used over time. Between 2006 and 2010, there were significant declines in all outcomes, including six-month all cause mortality (7.1% in 2006, 6.5% 2010; adjusted OR 0.88; 95% CI 0.82-0.95), six-month re-hospitalization (36.3% in 2006, 33.7% in 2010; OR 0.87; 95% CI 0.83-0.91) and device-related complications (5.8% in 2006, 4.8% in 2010; OR 0.80; 95% CI 0.74-0.88).
Conclusions—The clinical characteristics of Medicare patients undergoing primary prevention ICD implantation were stable between 2006 and 2010. Simultaneous improvements in outcomes suggest meaningful advances in the care for this patient population.
- Received January 9, 2014.
- Revision received June 2, 2014.
- Accepted June 16, 2014.