Implantable cardioverter defibrillator utilization based on discharge diagnoses from medicare and managed care patients

Jeremy N. Ruskin, A. John Camm, Douglas P. Zipes, Alfred P. Hallstrom, Mary E. Mcgrory-Usset

Research output: Contribution to journalArticle

76 Scopus citations

Abstract

Introduction: Implantable cardioverter defibrillators (ICDs) have become an accepted therapy for patients at high risk of sudden cardiac death. To assess the current utilization of this therapy, we estimated the number of patients at risk of sudden death using an historical claims-based study and compared these results to current ICD usage volumes. Methods and Results: Managed care and Medicare databases (claims related to 4.6 million covered U.S. lives during a 12-month period) were analyzed to identify patients who had either a primary or secondary diagnosis of ventricular tachycardia, ventricular fibrillation, ventricular flutter, or cardiac arrest. These patients were further required to have a diagnosis code indicating a previous myocardial infarction or congestive heart failure. Patients who died during the study period or did not have medical insurance were excluded. In the base case scenario, 1,226 patients per million population were identified as potential ICD candidates. Sensitivity analyses reduced that value to a range from 736 to 1,140 ICD candidates per million population. Sensitivity factors considered included acute myocardial infarction, comorbidities, age, secondary ventricular tachycardia/ventricular fibrillation diagnosis, and varying degrees of left ventricular dysfunction. These results contrast with an ICD usage rate of 416 per million population in the United States and lower rates in other countries. Conclusion: This study suggests that, based on discharge diagnoses, many patients who could benefit from ICDs are not receiving this therapy. Diverse reasons for this underutilization should be addressed to improve access to, and appropriate use of, this therapy.

Original languageEnglish (US)
Pages (from-to)38-43
Number of pages6
JournalJournal of Cardiovascular Electrophysiology
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2002

Keywords

  • Claims-based study
  • Implant rates
  • Implantable cardioverter defibrillator
  • Sudden cardiac death
  • Utilization
  • Ventricular fibrillation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

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