National Trends in the Utilization of Cardiac Resynchronization Therapy With or Without Implantable-Cardioverter Defibrillator
Background—Candidates for cardiac resynchronization therapy (CRT) receive either a biventricular pacemaker (CRT-P) or a biventricular pacemaker with an implantable-cardioverter defibrillator (ICD; CRT-D). Optimal device selection remains challenging as the benefit of ICD therapy may not be uniform, particularly in patients at competing risk of non-sudden death.
Methods and Results—In this serial cross-sectional study using the National Inpatient Sample database, we identified 311,086 admissions associated with CRT implant between 2006-2012. CRT-D was the most common device-type (86.1%), including in patients ≥75 years old with 5 or more Elixhauser comorbidities (75.5%). Multivariate predictors of CRT-D implant included demographic, clinical, and geographic factors: prior ventricular arrhythmia (rate ratio [RR], 1.14; 95% CI, 1.13-1.14), ischemic heart disease (RR, 1.11; 95% CI, 1.10-1.11), male gender (RR, 1.10; 95% CI, 1.09-1.10), black race (RR, 1.06; 95% CI: 1.04-1.07), and Northeast geographic region (RR, 1.06; 95% CI, 1.04-1.09). There was significant inter-hospital variation in the use of CRT-D (10-90 percentile range, 72.9% to 98.0% CRT-D).
Conclusions—The majority of patients in this contemporary US cohort underwent implantation of CRT-D. Predictors of CRT-D implant included demographic, clinical, and geographic factors. In patient subgroups predicted to have an attenuated benefit from ICD therapy (older adults with multiple comorbidities), CRT-D remained the dominant device type. An improved understanding of the determinants of device selection may aid in decision-making and ultimately better align patient risk with device benefit at the time of CRT implantation.
- Received August 10, 2015.
- Revision received November 24, 2015.
- Accepted November 30, 2015.