doi: 10.1161/CIRCEP.108.777888
Original Articles |
Patient and Implanting Physician Factors Associated With Mortality and Complications After Implantable Cardioverter-Defibrillator Implantation, 2002–2005
From the Center for Clinical and Genetic Economics (M.A.G., K.A.S., L.H.C.), Duke Clinical Research Institute (S.M.A., E.D.P., A.F.H.), and the Divisions of Cardiology (S.M.A., E.D.P., A.F.H.) and General Internal Medicine (K.A.S., L.H.C.), Department of Medicine, Duke University School of Medicine, Durham, NC
Correspondence to Sana M. Al-Khatib, MD, MHS, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715 E-mail alkha001{at}mc.duke.edu
Received March 5, 2008; accepted August 11, 2008.
Background— Little is known about factors that influence survival and complications after implantable cardioverter-defibrillator (ICD) implantation in routine clinical practice. We examined patient and implanting physician factors associated with outcomes of ICD therapy in Medicare beneficiaries from 2002 through 2005.
Methods and Results— We limited this analysis to patients aged 
65 with Medicare fee-for-service coverage who received an ICD between January 2002 and September 2005. The main outcome measures are time to postprocedural complications within 90 days and 1-year mortality. During the study period, 8581 patients had an ICD implanted by 1959 physicians. The number of procedures increased from 1644 in 2002 to 2374 in the first 3 quarters of 2005. The overall complication rate declined from 18.8% in 2002 to 14.2% in 2005 (P<0.001). Factors independently associated with an increased hazard of complications include chronic lung disease, dementia, renal disease, implantation by a thoracic surgeon, and implantation with removal/replacement. History of congestive heart failure, outpatient implantation, and more recent years of ICD implantation were associated with a lower risk of complications (P<0.05 for all factors). From 2002 to 2005, we observed a decline in 1-year mortality (P<0.001).
Conclusions— We observed an appreciable increase in the number of ICD implants, which was associated with a significant decrease in the rate of complications and 1-year mortality. We identified factors associated with an increased risk of mortality and postprocedural complications that may support more nuanced treatment decisions than are currently possible.
Key Words: complications • defibrillation • mortality
CLINICAL PERSPECTIVE
The online-only Data Supplement is available at http://circimaging.ahajournals.org/cgi/content/full/CIRCIMAGING.108.777888/DC1.
Related Articles
Circ Arrhythm Electrophysiol 2008 1: 235-237.
Circ Arrhythm Electrophysiol 2008 1: 240-249.
This article has been cited by other articles:
 |
|
 |
|
  W. C. Levy, K. L. Lee, A. S. Hellkamp, J. E. Poole, D. Mozaffarian, D. T. Linker, A. P. Maggioni, I. Anand, P. A. Poole-Wilson, D. P. Fishbein, et al. Maximizing Survival Benefit With Primary Prevention Implantable Cardioverter-Defibrillator Therapy in a Heart Failure Population Circulation, September 8, 2009; 120(10): 835 - 842. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. Curtis, J. Luebbert, and H. M. Krumholz Physician Certification and Implantable Cardioverter-Defibrillators--Reply JAMA, September 2, 2009; 302(9): 942 - 943. [Full Text] [PDF]
|
|
|
|
|
|
J. P. Curtis, J. J. Luebbert, Y. Wang, S. S. Rathore, J. Chen, P. A. Heidenreich, S. C. Hammill, R. I. Lampert, and H. M. Krumholz Association of Physician Certification and Outcomes Among Patients Receiving an Implantable Cardioverter-Defibrillator JAMA, April 22, 2009; 301(16): 1661 - 1670. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Hammill and J. Curtis Publicly Reporting Implantable Cardioverter Defibrillator Outcomes: Grading the Report Card Circ Arrhythm Electrophysiol, October 1, 2008; 1(4): 235 - 237. [Full Text] [PDF]
|
|