Appropriateness of implantable cardioverter-defibrillator device implants in the United States.

Autor:	Yousuf OK; Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Carient Heart & Vascular, Manassas, Virginia; Inova Heart and Vascular Institute, Fairfax, Virginia; University of Virginia Health, Manassas, Virginia. Electronic address: Omair.Yousuf@gmail.com., Kennedy K; Saint Luke's Mid America Heart Institute, Kansas City, Missouri., Russo A; Cooper Health, Voorhees, New Jersey., Varosy P; University of Colorado, Denver, Colorado., Lindsay BD; Cleveland Clinic, Cleveland, Ohio., Steinberg B; University of Utah, Salt Lake City, Utah., Atwater BD; Saint Luke's Mid America Heart Institute, Kansas City, Missouri; Inova Heart and Vascular Institute, Fairfax, Virginia., Calkins H; Johns Hopkins Medical Institution, Baltimore, Maryland., Spertus JA; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Jazyk:	angličtina
Zdroj:	Heart rhythm [Heart Rhythm] 2024 Apr; Vol. 21 (4), pp. 397-407. Date of Electronic Publication: 2023 Dec 18.
DOI:	10.1016/j.hrthm.2023.12.005
Abstrakt:	Background: The appropriate use criteria (AUCs) are a diverse group of indications aimed to better evaluate the benefits of implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy. Objective: The purpose of this study was to quantify the proportion of ICD and cardiac resynchronization therapy with defibrillator (CRT-D) implants as appropriate, may be appropriate (MA), or rarely appropriate (RA) on the basis of the AUC guidelines. Methods: This is a multicenter retrospective study of patients within the National Cardiovascular Data Registry undergoing ICD implantation between April 2018 and March 2019 at >1500 US hospitals. The appropriateness of ICD implants was adjudicated using the AUC. Results: Of 309,318 ICDs, 241,438 were primary prevention implants (78.1%) and 67,880 secondary prevention implants (21.9%); 243,532 (79%) were mappable to the AUC. For primary prevention, 185,431 ICDs (96.4%) were appropriate, 5660 (2.9%) MA, and 1205 (0.6%) RA. For secondary prevention, 47,498 ICDs (92.7%) were appropriate, 2581 (5%) MA, and 1157 (2.3%) RA. A significant number of RA devices were implanted in patients with New York Heart Association class IV heart failure who were ineligible for advanced therapies (53.9%) and those with myocardial infarction within 40 days (18.1%). The appropriateness of the pacing lead was more variable, with 48,470 dual-chamber ICD implants (62%) being classified as appropriate, 29,209 (37.4%) MA, and 448 (0.6%) RA. Among CRT-D implants, 63,848 (82.2%) were appropriate, 9900 (12.7%) MA, and 3940 (5.1%) RA for left ventricular pacing. A total of 99,754 implants were deemed appropriate but excluded from Centers for Medicare & Medicaid Services National Coverage Determination. More than 92% of hospitals had an RA implant rate of <4%. Conclusion: In this large national registry, 95% of mappable ICD and CRT-D implants were considered appropriate, with <2% of RA implants. Nearly 100,000 appropriate implants are excluded by Centers for Medicare & Medicaid Services National Coverage Determination. Competing Interests: Disclosures Dr Yousuf serves as a consultant for Medtronic, Boston Scientific, and Zoll and is a member of the American College of Cardiology NCDR Reporting and Methodologies Committee, Electrophysiology NCDR Registry Suite Steering Committee, Heart Rhythm Society's Digital Health Committee. Dr Atwater serves as a consultant for Medtronic, Abbott, Biotronik, Biosense Webster, and Bristol Myers Squibb. Dr Steinberg has received research support from National Insitutes of Health (#K23HL143156), American Heart Association/Patient-Centered Outcomes Research Institute (PCORI), Boston Scientific, Sanofi, and AltaThera and is consulting to Sanofi, InCarda, Milestone, Pfizer, and AltaThera. He also serves as Chair of the Steering Committee for the NCDR EP registries. Dr Calkins serves as a consultant for Biosense Webster, Medtronic, Abbott Medical, and AtriCure. The rest of the authors report no conflicts of interest. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
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