Impact of insurance status on ICD implantation practice patterns: Insights from the NCDR ICD registry
| Autor: | Rachel Lampert, Craig S. Parzynski, Imdad Ahmed, Faisal M. Merchant, Jeptha P. Curtis |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Cardiac resynchronization therapy 030204 cardiovascular system & hematology Insurance Coverage 03 medical and health sciences 0302 clinical medicine Humans Medicine Registries 030212 general & internal medicine Retrospective Studies Heart Failure Practice patterns business.industry Middle Aged Implantable cardioverter-defibrillator Defibrillators Implantable Icd implantation Primary Prevention Death Sudden Cardiac Insurance status Emergency medicine Female Cardiology and Cardiovascular Medicine business Complication Medical therapy |
| Zdroj: | American Heart Journal. 235:44-53 |
| ISSN: | 0002-8703 |
| DOI: | 10.1016/j.ahj.2021.01.016 |
| Popis: | Whether insurance status influences practice patterns in implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) defibrillators, when indicated, is not known.We analyzed the NCDR ICD Registry to evaluate associations of insurance status with guidelines-based receipt of CRT, as well as device-type, complication rates, and use of optimal medical therapy defined by guidelines. Among 798,028 patients with de novo ICD implants, we included only patients65 years (those older have Medicare) and excluded those admitted before 2006 (n=1,835) or with insurance coverage other than Medicare, Medicaid or private insurance (n=25,695) leaving 286,556 for analysis. Inverse probability of treatment weighting was used to control for imbalances between groups. Mean age was 53 years, 29% were female. Patients with private insurance and Medicare were more likely to receive CRT-D when indicated (79.6%, OR 1.19 95% CI 1.09-1.28, P.001 and 78.5%, OR 1.11 95% CI 1.01-1.21 P = .03, respectively) compared to the uninsured (76.7%). The uninsured were also more likely than other groups to receive a single-chamber device. Complication rates did not differ. Uninsured patients were, however, more likely to receive optimal medical therapy, particularly in the subgroup receiving the implant for primary prevention.In propensity-weighted analysis, uninsured patients are less likely to receive CRT when indicated but more likely to be receiving optimal medical therapy at discharge. Reasons for differences in device implantation practices based on insurance status require further study. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect