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Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States.

Publication ,  Journal Article
Friedman, DJ; Parzynski, CS; Varosy, PD; Prutkin, JM; Patton, KK; Mithani, A; Russo, AM; Curtis, JP; Al-Khatib, SM
Published in: JAMA Cardiol
November 1, 2016

IMPORTANCE: Trends and in-hospital outcomes associated with early adoption of the subcutaneous implantable cardioverter defibrillator (S-ICD) in the United States have not been described. OBJECTIVES: To describe early use of the S-ICD in the United States and to compare in-hospital outcomes among patients undergoing S-ICD vs transvenous (TV)-ICD implantation. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of 393 734 ICD implants reported to the National Cardiovascular Data Registry ICD Registry, a nationally representative US ICD registry, between September 28, 2012 (US Food and Drug Administration S-ICD approval date), and March 31, 2015, was conducted. A 1:1:1 propensity-matched analysis of 5760 patients was performed to compare in-hospital outcomes among patients with S-ICD with those of patients with single-chamber (SC)-ICD and dual-chamber (DC)-ICD. MAIN OUTCOMES AND MEASURES: Analysis of trends in S-ICD adoption as a function of total ICD implants and comparison of in-hospital outcomes (death, complications, and defibrillation threshold [DFT] testing) among S-ICD and TV-ICD recipients. RESULTS: Of the 393 734 ICD implants evaluated during the study period, 3717 were S-ICDs (0.9%). A total of 109 445 (27.8%) of the patients were female; the mean (SD) age was 67.03 (13.10) years. Use of ICDs increased from 0.2% during the fourth quarter of 2012 to 1.9% during the first quarter of 2015. Compared with SC-ICD and DC-ICD recipients, those with S-ICDs were more often younger, female, black, undergoing dialysis, and had experienced prior cardiac arrest. Among 2791 patients with S-ICD who underwent DFT testing, 2588 (92.7%), 2629 (94.2%), 2635 (94.4%), and 2784 (99.7%) were successfully defibrillated (≤65, ≤70, ≤75, and ≤80 J, respectively). In the propensity-matched analysis of 5760 patients, in-hospital complication rates associated with S-ICDs (0.9%) were comparable to those of SC-ICDs (0.6%) (P = .27) and DC-ICD rates (1.5%) (P = .11). Mean (SD) length of stay after S-ICD implantation was comparable to that after SC-ICD implantation (1.1 [1.5] vs 1.0 [1.2] days; P = .77) and less than after DC-ICD implantation (1.1 [1.5] vs 1.2 [1.5] days; P < .001). CONCLUSIONS AND RELEVANCE: The use of S-ICDs is rapidly increasing in the United States. Early adoption has been associated with low complication rates and high rates of successful DFT testing despite frequent use in patients with a high number of comorbidities.

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Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

November 1, 2016

Volume

1

Issue

8

Start / End Page

900 / 911

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Renal Dialysis
  • Registries
  • Middle Aged
  • Male
  • Inpatients
  • Humans
  • Heart Arrest
 

Citation

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Friedman, D. J., Parzynski, C. S., Varosy, P. D., Prutkin, J. M., Patton, K. K., Mithani, A., … Al-Khatib, S. M. (2016). Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States. JAMA Cardiol, 1(8), 900–911. https://doi.org/10.1001/jamacardio.2016.2782
Friedman, Daniel J., Craig S. Parzynski, Paul D. Varosy, Jordan M. Prutkin, Kristen K. Patton, Ali Mithani, Andrea M. Russo, Jeptha P. Curtis, and Sana M. Al-Khatib. “Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States.JAMA Cardiol 1, no. 8 (November 1, 2016): 900–911. https://doi.org/10.1001/jamacardio.2016.2782.
Friedman DJ, Parzynski CS, Varosy PD, Prutkin JM, Patton KK, Mithani A, et al. Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States. JAMA Cardiol. 2016 Nov 1;1(8):900–11.
Friedman, Daniel J., et al. “Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States.JAMA Cardiol, vol. 1, no. 8, Nov. 2016, pp. 900–11. Pubmed, doi:10.1001/jamacardio.2016.2782.
Friedman DJ, Parzynski CS, Varosy PD, Prutkin JM, Patton KK, Mithani A, Russo AM, Curtis JP, Al-Khatib SM. Trends and In-Hospital Outcomes Associated With Adoption of the Subcutaneous Implantable Cardioverter Defibrillator in the United States. JAMA Cardiol. 2016 Nov 1;1(8):900–911.

Published In

JAMA Cardiol

DOI

EISSN

2380-6591

Publication Date

November 1, 2016

Volume

1

Issue

8

Start / End Page

900 / 911

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Renal Dialysis
  • Registries
  • Middle Aged
  • Male
  • Inpatients
  • Humans
  • Heart Arrest