Trends in Use of Single- vs Dual-Chamber Implantable Cardioverter-Defibrillators Among Patients Without a Pacing Indication, 2010-2018.

Autor:	Borne RT; Division of Cardiology, University of Colorado Health, Colorado Springs., Varosy P; Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora.; Cardiology Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado., Lan Z; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut., Masoudi FA; Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora.; Research and Analytics, Ascension Health, St Louis, Missouri., Curtis JP; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut.; Division of Cardiology, Yale University School of Medicine, New Haven, Connecticut., Matlock DD; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.; Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, Denver., Peterson PN; Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora.; Division of Cardiology, Denver Health Hospital, Denver, Colorado.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2022 Mar 01; Vol. 5 (3), pp. e223429. Date of Electronic Publication: 2022 Mar 01.
DOI:	10.1001/jamanetworkopen.2022.3429
Abstrakt:	Importance: Use of dual-chamber implantable cardioverter-defibrillator (ICD) systems among patients without a pacing indication is an example of low-value care given higher procedural risks, higher costs, and little evidence for benefit from an atrial lead. However, variation in the use of dual-chamber systems was present among patients without a pacing indication. Objective: To examine the temporal trends and hospital variation in use of single- and dual-chamber ICD implantation among patients without a pacing indication undergoing first-time ICD implantation. Design, Setting, and Participants: A multicenter cross-sectional study was conducted using the US National Cardiovascular Data Registry ICD Registry. A total of 266 182 patients undergoing initial implantation of a single- or dual-chamber transvenous ICD without a bradycardia pacing indication, class I or II cardiac resynchronization therapy indication, or history of atrial fibrillation or atrial flutter were included. The study was conducted from April 1, 2010, to December 31, 2018; data analysis was performed from October 19, 2020, to January 5, 2022. Exposures: Implantation of a single- or dual-chamber ICD. Main Outcomes and Measures: Temporal trends among patients undergoing single- vs dual-chamber ICDs were determined using the Cochran-Armitage trend test, and hospital-level variation using adjusted hospital median odds ratios was examined. Results: A total of 266 182 patients (single-chamber ICD, 134 925; dual-chamber ICD, 131 257) were included in this analysis; mean (SD) age was 58.0 (14.0) years and 91 990 patients (68.2%) were men. The use of dual-chamber ICDs decreased from 64.7% (n = 15 694) in 2010 to 42.2% (n = 9762) in 2018 (P < .001). Adjusted for patient characteristics, the median hospital-level proportion of single-chamber ICDs increased from 42.9% (95% CI, 42.6%-45.0%) in 2010 to 50.0% (95% CI, 47.8%-51.0%) in 2018. The median odds ratio for the use of dual-chamber ICDs, adjusted for patient characteristics, was 1.6 (95% CI, 1.6-1.8) in 2010 and 1.5 (95% CI, 1.5-1.8) in 2018, indicating decreasing but persistent variation in use. Conclusions and Relevance: In this national study of US patients undergoing first-time ICD implantation without a clinical indication for an atrial lead, the use of dual-chamber devices decreased. However, institutional variability in the use of atrial leads persists, suggesting differences in individual or institutional cultures of real-world practice and opportunity to reduce this low-value practice.
Databáze:	MEDLINE
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