Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter-Defibrillators in the Cardiovascular Research Network.

Autor: Greenlee RT; Marshfield Clinic, Marshfield, WI greenlee.robert@marshfieldresearch.org., Go AS; Kaiser Permanente Northern California, Oakland, CA., Peterson PN; Denver Health Medical Center, Denver, CO.; University of Colorado Anschutz Medical Campus, Aurora, CO., Cassidy-Bushrow AE; Henry Ford Health System, Detroit, MI., Gaber C; University of Michigan, Ann Arbor, MI., Garcia-Montilla R; Marshfield Clinic, Marshfield, WI., Glenn KA; Kaiser Permanente Colorado, Denver, CO., Gupta N; Kaiser Los Angeles Medical Center, Los Angeles, CA., Gurwitz JH; University of Massachusetts Medical School, Worcester, MA., Hammill SC; Mayo Clinic, Rochester, MN., Hayes JJ; Marshfield Clinic, Marshfield, WI., Kadish A; Touro College, New York, NY., Magid DJ; Kaiser Permanente Colorado, Denver, CO., McManus DD; University of Massachusetts Medical School, Worcester, MA., Multerer D; Marshfield Clinic, Marshfield, WI., Powers JD; Kaiser Permanente Colorado, Denver, CO., Reifler LM; Kaiser Permanente Colorado, Denver, CO., Reynolds K; Kaiser Permanente Southern California, Pasadena, CA., Schuger C; University of Michigan, Ann Arbor, MI., Sharma PP; Marshfield Clinic, Marshfield, WI., Smith DH; Kaiser Permanente Northwest, Portland, OR., Suits M; Marshfield Clinic, Marshfield, WI., Sung SH; Kaiser Permanente Northern California, Oakland, CA., Varosy PD; Department of Veterans Affairs Eastern Colorado Health System, Denver, CO., Vidaillet HJ; Marshfield Clinic, Marshfield, WI., Masoudi FA; University of Colorado Anschutz Medical Campus, Aurora, CO.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2018 Mar 26; Vol. 7 (7). Date of Electronic Publication: 2018 Mar 26.
DOI: 10.1161/JAHA.117.008292
Abstrakt: Background: Primary prevention implantable cardioverter-defibrillators (ICDs) reduce mortality in selected patients with left ventricular systolic dysfunction by delivering therapies (antitachycardia pacing or shocks) to terminate potentially lethal arrhythmias; inappropriate therapies also occur. We assessed device therapies among adults receiving primary prevention ICDs in 7 healthcare systems.
Methods and Results: We linked medical record data, adjudicated device therapies, and the National Cardiovascular Data Registry ICD Registry. Survival analysis evaluated therapy probability and predictors after ICD implant from 2006 to 2009, with attention to Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups: left ventricular ejection fraction, 31% to 35%; nonischemic cardiomyopathy <9 months' duration; and New York Heart Association class IV heart failure with cardiac resynchronization therapy defibrillator. Among 2540 patients, 35% were <65 years old, 26% were women, and 59% were white. During 27 (median) months, 738 (29%) received ≥1 therapy. Three-year therapy risk was 36% (appropriate, 24%; inappropriate, 12%). Appropriate therapy was more common in men (adjusted hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.43-2.35). Inappropriate therapy was more common in patients with atrial fibrillation (adjusted HR, 2.20; 95% CI, 1.68-2.87), but less common among patients ≥65 years old versus younger (adjusted HR, 0.72; 95% CI, 0.54-0.95) and in recent implants (eg, in 2009 versus 2006; adjusted HR, 0.66; 95% CI, 0.46-0.95). In Centers for Medicare and Medicaid Services Coverage With Evidence Development analysis, inappropriate therapy was less common with cardiac resynchronization therapy defibrillator versus single chamber (adjusted HR, 0.55; 95% CI, 0.36-0.84); therapy risk did not otherwise differ for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups.
Conclusions: In this community cohort of primary prevention patients receiving ICD, therapy delivery varied across demographic and clinical characteristics, but did not differ meaningfully for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups.
(© 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
Databáze: MEDLINE
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