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Non-evidence-based ICD implantations in the United States.

Publication ,  Journal Article
Al-Khatib, SM; Hellkamp, A; Curtis, J; Mark, D; Peterson, E; Sanders, GD; Heidenreich, PA; Hernandez, AF; Curtis, LH; Hammill, S
Published in: JAMA
January 5, 2011

CONTEXT: Practice guidelines do not recommend use of an implantable cardioverter-defibrillator (ICD) for primary prevention in patients recovering from a myocardial infarction or coronary artery bypass graft surgery and those with severe heart failure symptoms or a recent diagnosis of heart failure. OBJECTIVE: To determine the number, characteristics, and in-hospital outcomes of patients who receive a non-evidence-based ICD and examine the distribution of these implants by site, physician specialty, and year of procedure. DESIGN, SETTING, AND PATIENTS: Retrospective cohort study of cases submitted to the National Cardiovascular Data Registry-ICD Registry between January 1, 2006, and June 30, 2009. MAIN OUTCOME MEASURE: In-hospital outcomes. RESULTS: Of 111,707 patients, 25,145 received non-evidence-based ICD implants (22.5%). Patients who received a non-evidence-based ICD compared with those who received an evidence-based ICD had a significantly higher risk of in-hospital death (0.57% [95% confidence interval {CI}, 0.48%-0.66%] vs 0.18% [95% CI, 0.15%-0.20%]; P <.001) and any postprocedure complication (3.23% [95% CI, 3.01%-3.45%] vs 2.41% [95% CI, 2.31%-2.51%]; P <.001). There was substantial variation in non-evidence-based ICDs by site. The rate of non-evidence-based ICD implants was significantly lower for electrophysiologists (20.8%; 95% CI, 20.5%-21.1%) than nonelectrophysiologists (24.8% [95% CI, 24.2%-25.3%] for nonelectrophysiologist cardiologists; 36.1% [95% CI, 34.3%-38.0%] for thoracic surgeons; and 24.9% [95% CI, 23.8%-25.9%] for other specialties) (P<.001 for all comparisons). There was no clear decrease in the rate of non-evidence-based ICDs over time (24.5% [6908/28,233] in 2006, 21.8% [7395/33,965] in 2007, 22.0% [7245/32,960] in 2008, and 21.7% [3597/16,549] in 2009; P <.001 for trend from 2006-2009 and P = .94 for trend from 2007-2009). CONCLUSION: Among patients with ICD implants in this registry, 22.5% did not meet evidence-based criteria for implantation.

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

January 5, 2011

Volume

305

Issue

1

Start / End Page

43 / 49

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Registries
  • Primary Prevention
  • Practice Patterns, Physicians'
  • Patient Selection
  • Myocardial Infarction
  • Middle Aged
  • Male
 

Citation

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Chicago
ICMJE
MLA
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Al-Khatib, S. M., Hellkamp, A., Curtis, J., Mark, D., Peterson, E., Sanders, G. D., … Hammill, S. (2011). Non-evidence-based ICD implantations in the United States. JAMA, 305(1), 43–49. https://doi.org/10.1001/jama.2010.1915
Al-Khatib, Sana M., Anne Hellkamp, Jeptha Curtis, Daniel Mark, Eric Peterson, Gillian D. Sanders, Paul A. Heidenreich, Adrian F. Hernandez, Lesley H. Curtis, and Stephen Hammill. “Non-evidence-based ICD implantations in the United States.JAMA 305, no. 1 (January 5, 2011): 43–49. https://doi.org/10.1001/jama.2010.1915.
Al-Khatib SM, Hellkamp A, Curtis J, Mark D, Peterson E, Sanders GD, et al. Non-evidence-based ICD implantations in the United States. JAMA. 2011 Jan 5;305(1):43–9.
Al-Khatib, Sana M., et al. “Non-evidence-based ICD implantations in the United States.JAMA, vol. 305, no. 1, Jan. 2011, pp. 43–49. Pubmed, doi:10.1001/jama.2010.1915.
Al-Khatib SM, Hellkamp A, Curtis J, Mark D, Peterson E, Sanders GD, Heidenreich PA, Hernandez AF, Curtis LH, Hammill S. Non-evidence-based ICD implantations in the United States. JAMA. 2011 Jan 5;305(1):43–49.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

January 5, 2011

Volume

305

Issue

1

Start / End Page

43 / 49

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Retrospective Studies
  • Registries
  • Primary Prevention
  • Practice Patterns, Physicians'
  • Patient Selection
  • Myocardial Infarction
  • Middle Aged
  • Male