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. 2016 Jan;43(1):115-27.
doi: 10.1002/jmri.24971. Epub 2015 Jun 27.

Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators

Saman Nazarian  1 , Matthew R Reynolds  2 , Michael P Ryan  3 , Steven D Wolff  4 , Sarah A Mollenkopf  5 , Mintu P Turakhia  6
Affiliations

Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators

Saman Nazarian et al. J Magn Reson Imaging. 2016 Jan.

Abstract

Purpose: To examine imaging utilization in a matched cohort of patients with and without implantable cardioverter defibrillators (ICD) and to project magnetic resonance imaging (MRI) utilization over a 10-year period.

Materials and methods: The Truven Health MarketScan Commercial claims and Medicare Supplemental health insurance claims data were used to identify patients with continuous health plan enrollment in 2009-2012. Patients with ICDs were identified using ICD-9 and CPT codes, and matched to patients with the same demographic and comorbidity profile, but no record of device implantation. Diagnostic imaging utilization was compared across the matched cohorts, in total, by imaging categories, and in subpopulations of stroke, back pain, and joint pain. MRI use in the nonimplant group over the 4-year period was extrapolated out to 10 years for ICD-indicated patients.

Results: A cohort of 18,770 matched patients were identified; average age 65.5 ± 13.38 and 21.9% female. ICD patients had significantly less MRI imaging (0.23 0.70 SD vs. 0.00 0.08 SD, P < 0.0001) than nonimplant patients. Among patients with records of stroke/transient ischemic attack (TIA) (ICD 5%, nonimplant 4%) and accompanying diagnostic imaging, 44% of nonimplant patients underwent MRI vs. 1% of ICD patients (P < 0.0001). Forecast models estimated that 53% to 64% of ICD-eligible patients may require an MRI within 10 years.

Conclusion: MRI utilization is lower in ICD patients compared to nonimplant patients, yet the burden of incident stroke/TIA, back, and joint pain suggests an unmet need for MR-conditional devices.

Keywords: defibrillation; healthcare utilization; heart-assist device; implantable cardioverter defibrillators; magnetic resonance imaging.

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Figures

Figure 1
Figure 1
Patient attrition diagram. ICD: implantable cardioverter defibrillator.
Figure 2
Figure 2
A: Total number of procedures for each cohort by radiology category. B: Number of patients for each cohort by radiology category. ICD: implantable cardioverter defibrillator; CT: computed tomography; CTA: computed tomography angiography; MRI: magnetic resonance imaging; MRA: magnetic resonance angiogram.
Figure 3
Figure 3
A: Percentage of patients with stroke/TIA event by radiology type. B: Percentage of patients with back pain by radiology type. C: Percentage of patients with joint pain by radiology type. ICD: implantable cardioverter defibrillator; CT: computed tomography; CTA: computed tomography angiography; MRI: magnetic resonance imaging; MRA: magnetic resonance angiogram.
Figure 4
Figure 4
MRI/MRA use by ICD‐indicated patients and projected utilization to 10 years. The black line represents the proportion of ICD‐indicated patients who received an MRI or MRA at 1, 2, 3, and 4 years. The lines extending after year 4 show two projections, which are high and low estimates of utilization. MRI: magnetic resonance imaging; MRA: magnetic resonance angiogram; ICD: implantable cardioverter defibrillator.
See this image and copyright information in PMC

References

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