Utilization rates of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: A 2012 calculation for a midwestern health referral region

Allen Hoang, Changyu Shen, James Zheng, Stanley Taylor, William J. Groh, Marc Rosenman, Alfred E. Buxton, Peng Sheng Chen

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background Utilization rates (URs) for implantable cardioverter- defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. Objective The purpose of this study was to establish the ICD UR in central Indiana. Methods A query run on 2 hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) <0.35. ICD eligibility and utilization were determined from chart review. Results We identified 1863 patients with at least 1 low EF study. Two cohorts were analyzed: 1672 patients without and 191 patients with International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% confidence interval [CI] 28%-49%). URs were 48% for males (95% CI 34%-61%), 21% for females (95% CI 16%-26%, P =.0002 vs males), 40% for whites (95% CI 27%-53%), and 37% for blacks (95% CI 28%-46%, P =.66 vs whites). Conclusion ICD UR is 38% among patients meeting class I indications, suggesting further opportunities for improving guideline compliance. This study also illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review.

Original languageEnglish (US)
Pages (from-to)849-855
Number of pages7
JournalHeart Rhythm
Volume11
Issue number5
DOIs
StatePublished - May 2014

Fingerprint

Implantable Defibrillators
Sudden Cardiac Death
Primary Prevention
Referral and Consultation
Health
Confidence Intervals
International Classification of Diseases
Stroke Volume
Compliance

Keywords

  • Arrhythmia
  • Defibrillator
  • Implantable cardioverter-defibrillator
  • Sudden cardiac death
  • Utilization

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)
  • Medicine(all)

Cite this

Utilization rates of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death : A 2012 calculation for a midwestern health referral region. / Hoang, Allen; Shen, Changyu; Zheng, James; Taylor, Stanley; Groh, William J.; Rosenman, Marc; Buxton, Alfred E.; Chen, Peng Sheng.

In: Heart Rhythm, Vol. 11, No. 5, 05.2014, p. 849-855.

Research output: Contribution to journalArticle

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title = "Utilization rates of implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: A 2012 calculation for a midwestern health referral region",
abstract = "Background Utilization rates (URs) for implantable cardioverter- defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. Objective The purpose of this study was to establish the ICD UR in central Indiana. Methods A query run on 2 hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) <0.35. ICD eligibility and utilization were determined from chart review. Results We identified 1863 patients with at least 1 low EF study. Two cohorts were analyzed: 1672 patients without and 191 patients with International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16{\%}) had no ICD but had class I indications for ICD. Eight of 300 (2.7{\%}) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38{\%} overall (95{\%} confidence interval [CI] 28{\%}-49{\%}). URs were 48{\%} for males (95{\%} CI 34{\%}-61{\%}), 21{\%} for females (95{\%} CI 16{\%}-26{\%}, P =.0002 vs males), 40{\%} for whites (95{\%} CI 27{\%}-53{\%}), and 37{\%} for blacks (95{\%} CI 28{\%}-46{\%}, P =.66 vs whites). Conclusion ICD UR is 38{\%} among patients meeting class I indications, suggesting further opportunities for improving guideline compliance. This study also illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review.",
keywords = "Arrhythmia, Defibrillator, Implantable cardioverter-defibrillator, Sudden cardiac death, Utilization",
author = "Allen Hoang and Changyu Shen and James Zheng and Stanley Taylor and Groh, {William J.} and Marc Rosenman and Buxton, {Alfred E.} and Chen, {Peng Sheng}",
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AU - Taylor, Stanley

AU - Groh, William J.

AU - Rosenman, Marc

AU - Buxton, Alfred E.

AU - Chen, Peng Sheng

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N2 - Background Utilization rates (URs) for implantable cardioverter- defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. Objective The purpose of this study was to establish the ICD UR in central Indiana. Methods A query run on 2 hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) <0.35. ICD eligibility and utilization were determined from chart review. Results We identified 1863 patients with at least 1 low EF study. Two cohorts were analyzed: 1672 patients without and 191 patients with International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% confidence interval [CI] 28%-49%). URs were 48% for males (95% CI 34%-61%), 21% for females (95% CI 16%-26%, P =.0002 vs males), 40% for whites (95% CI 27%-53%), and 37% for blacks (95% CI 28%-46%, P =.66 vs whites). Conclusion ICD UR is 38% among patients meeting class I indications, suggesting further opportunities for improving guideline compliance. This study also illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review.

AB - Background Utilization rates (URs) for implantable cardioverter- defibrillators (ICDs) for primary prevention of sudden cardiac death (PPSCD) are lacking in the community. Objective The purpose of this study was to establish the ICD UR in central Indiana. Methods A query run on 2 hospitals in a health information exchange database in Indianapolis identified patients between 2011 and 2012 with left ventricular ejection fraction (EF) <0.35. ICD eligibility and utilization were determined from chart review. Results We identified 1863 patients with at least 1 low EF study. Two cohorts were analyzed: 1672 patients without and 191 patients with International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 37.94 for ICD placement. We manually reviewed a stratified (by hospital) random sample of 300 patients from the no-ICD procedure code cohort and found that 48 (16%) had no ICD but had class I indications for ICD. Eight of 300 (2.7%) actually had ICD implantation for PPSCD. Review of all 191 patients in the ICD procedure code cohort identified 70 with ICD implantation for PPSCD. The ICD UR (ratio between patients with ICD for PPSCD and all with indication) was 38% overall (95% confidence interval [CI] 28%-49%). URs were 48% for males (95% CI 34%-61%), 21% for females (95% CI 16%-26%, P =.0002 vs males), 40% for whites (95% CI 27%-53%), and 37% for blacks (95% CI 28%-46%, P =.66 vs whites). Conclusion ICD UR is 38% among patients meeting class I indications, suggesting further opportunities for improving guideline compliance. This study also illustrates limitations in calculating ICD UR using large electronic repositories without hands-on chart review.

KW - Arrhythmia

KW - Defibrillator

KW - Implantable cardioverter-defibrillator

KW - Sudden cardiac death

KW - Utilization

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