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CARDIAC ARREST

Utilization of implantable cardioverter-defibrillators in survivors of cardiac arrest in the United States from 1996 to 2001

Andrew Voigt, MD^*, Rana Ezzeddine, PhD, William Barrington, MD^*, Ogundu Obiaha-Ngwu, MD^*, Leonard I. Ganz, MD^*, Barry London, MD, PhD^* and Samir Saba, MD^*,*

^* Cardiovascular Institute
Department of Biostatistics, University of Pittsburgh, Pittsburgh, PennsylvaniaUSA

Manuscript received March 15, 2004; revised manuscript received April 23, 2004, accepted May 3, 2004.

^* Reprint requests and correspondence: Dr. Samir Saba, Division of Cardiac Electrophysiology, University of Pittsburgh Medical Center, 200 Lothrop Street, B535 PUH, Pittsburgh, Pennsylvania 15213 (Email: sabas{at}msx.upmc.edu).

OBJECTIVES: We analyzed the incidence of implantable cardioverter-defibrillator (ICD) therapy in survivors of cardiac arrest (CA) in the U.S. from 1996 through 2001.

BACKGROUND: Cardiac arrest is a class I indication for ICD therapy. The current patterns of ICD utilization in survivors of CA have not been fully examined.

METHODS: We searched a representative sample of all hospital discharges for patients admitted with the primary diagnosis of CA who survived to hospital discharge. Patients with a concomitant diagnosis of acute myocardial infarction or previous ICD in situ were excluded.

RESULTS: From 1996 to 2001, 113,262 patients were admitted for CA. Of those, 63,745 (56.3%) did not survive to hospital discharge. Of the remaining 49,517 patients, 30.7% received an ICD before discharge, with a gradual increase in implantation rates from 1996 (23.6%) to 2001 (46.3%). Using logistic regression for the years 2000 and 2001, patients who were discharged without an ICD were older (odds ratio [OR] 0.93 for every 10-year increase in age, p < 0.001), more likely to be African American (OR 0.19, p < 0.001), and more likely to be admitted to a smaller hospital (OR 2.24 for each additional 100 beds, p < 0.001). These predictors were independent of other co-morbid illnesses.

CONCLUSIONS: Although they are increasing, the rates of ICD therapy after CA remain very low. There are gross discrepancies by race. At a time when newer indications for ICD implantation are emerging, efforts should be focused on identifying the causes of this underutilization and discrepancies in survivors of CA.

Abbreviations and Acronyms   CA = cardiac arrest   ICD = implantable cardioverter-defibrillator   ICD-9-CM = International Classification of Disease-9th Revision-Clinical Modification   MI = myocardial infarction   NHDS = National Hospital Discharge Survey   OR = odds ratio   VF = ventricular fibrillation

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