Arrhythmias & electrophysiology
Appropriateness of implantable cardioverter-defibrillator device implants in the United States
Authors' conclusion
In this large national registry, 95% of mappable ICD and CRT-D implants were considered appropriate, with <2% of RA implants.
Study context
- Population
- Patients undergoing implantable cardioverter-defibrillator (ICD) implantation at >1500 US hospitals, April 2018–March 2019243,532 (79%) mappable to AUC
- Participants
- 309,318 patients
- Exposure
- Primary prevention vs Secondary prevention
- Primary preventionn = 241,438
- Secondary preventionn = 67,880
- Outcome
- Proportion of ICD and CRT-D implants appropriate, may be appropriate (MA) or rarely appropriate (RA) by appropriate use criteria
Methodological detailsmulticentre, registry-based (National Cardiovascular Data Registry), >1500 US hospitals
- Multicentre
- Registry-based (National Cardiovascular Data Registry)
- >1500 US hospitals
Main finding
As reported in the abstract
Appropriateness of ICD implants by AUC
| Group | Appropriate | MA | Rarely appropriate (RA) |
|---|---|---|---|
| Primary prevention | 185,431 (96.4%) | 5660 (2.9%) | 1205 (0.6%) |
| Secondary prevention | 47,498 (92.7%) | 2581 (5%) | 1157 (2.3%) |
Appropriate
Primary prevention185,431 (96.4%)
Secondary prevention47,498 (92.7%)
MA
Primary prevention5660 (2.9%)
Secondary prevention2581 (5%)
Rarely appropriate (RA)
Primary prevention1205 (0.6%)
Secondary prevention1157 (2.3%)
Observational data: associations, not effects.
Further findings
Indications among RA implants
- NYHA class IV HF ineligible for advanced therapies
- 53.9%
- MI within 40 days
- 18.1%
Appropriateness of dual-chamber pacing lead
- Appropriate
- 48,470 (62%)
- MA
- 29,209 (37.4%)
- RA
- 448 (0.6%)
Appropriateness of cardiac resynchronization therapy with defibrillator (CRT-D) for LV pacing
- Appropriate
- 63,848 (82.2%)
- MA
- 9900 (12.7%)
- RA
- 3940 (5.1%)
Appropriate implants excluded from CMS National Coverage Determination
- Appropriate but excluded from CMS NCD
- 99,754
Hospital-level RA implant rate
- Hospitals with RA implant rate <4%
- >92%
Original publication
Appropriateness of implantable cardioverter-defibrillator device implants in the United States. Heart Rhythm. Published 18 December 2023. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →