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. 2012 Apr 23;172(8):634-41; discussion 641.
doi: 10.1001/archinternmed.2012.394.

Variation in use of dual-chamber implantable cardioverter-defibrillators: results from the national cardiovascular data registry

Dan D Matlock  1 , Pamela N Peterson, Yongfei Wang, Jeptha P Curtis, Matthew R Reynolds, Paul D Varosy, Frederick A Masoudi
Affiliations

Variation in use of dual-chamber implantable cardioverter-defibrillators: results from the national cardiovascular data registry

Dan D Matlock et al. Arch Intern Med. .

Abstract

Background: Among patients without an indication for a pacemaker, current evidence is inconclusive whether a dual-chamber implantable cardioverter-defibrillator (ICD) is superior to a single-chamber ICD. The current use of dual-chamber ICDs is not well characterized.

Methods: We conducted a cross-sectional study exploring hospital-level variation in the use of dual-chamber ICDs across the United States. Patients receiving a primary prevention ICD from 2006 through 2009 without a documented indication for a pacemaker were included. Multivariate hierarchical logistic regression was used to explore patient, health care provider, and physician factors related to the use of a dual-chamber device.

Results: Dual-chamber devices were implanted in 58% of the 87,115 patients without a pacing indication among 1293 hospitals, with hospital rates ranging from 0% in 33 centers to 100% in 109 centers. In multivariate analysis, geographic region was a strong independent predictor of dual-chamber device use, ranging from 36.4% in New England (reference region) to 66.4% in the Pacific region (odds ratio [OR], 5.25; 95% CI, 3.35-8.21). Hospital clustering was assessed using a median OR which was 3.96, meaning that 2 identical patients at different hospitals would have nearly a 4-fold difference in their chance of receiving a dual-chamber ICD.

Conclusions: Use of dual-chamber ICDs for the primary prevention of sudden cardiac death among patients without an indication for permanent pacing varies markedly at the hospital level in the United States. This is a clear example of how practice can vary independent of patient factors.

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Figures

Figure 1.
Figure 1.
Study sample. ICD, implantable cardioverter-defibrillator; NCDR, National Cardiovascular Data Registry; QRS, QRS interval duration.
Figure 2.
Figure 2.
Percentage of primary prevention patients who received a discretionary dual-chamber implantable cardioverter-defibrillator (ICD) by hospital.
Figure 3.
Figure 3.
Percentage of primary prevention patients who received a discretionary dual-chamber implantable cardioverter-defibrillator (ICD) by physician.
Figure 4.
Figure 4.
Proportion of patients receiving a dual-chamber implantable cardioverter-defibrillator by hospital referral region.
See this image and copyright information in PMC

References

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