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.
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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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