CLINICAL RESEARCH: HEART RHYTHM DISORDERS
The Relation Between Patients’ Outcomes and the Volume of Cardioverter-Defibrillator Implantation Procedures Performed by Physicians Treating Medicare Beneficiaries
Sana M. Al-Khatib, MD, MHS, FACC*,*,
F. Lee Lucas, PhD ,
James G. Jollis, MD*,
David J. Malenka, MD and
David E. Wennberg, MD
* Duke Clinical Research Institute, Durham, North Carolina
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine
Manuscript received December 28, 2004;
revised manuscript received April 11, 2005,
accepted May 11, 2005.
* Reprint requests and correspondence: Dr. Sana M. Al-Khatib, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 22715. (Email: alkha001{at}mc.duke.edu).
OBJECTIVES: The purpose of this study is to determine if implantable cardioverter-defibrillator (ICD) implantation should be limited to physicians with high procedural volume.
BACKGROUND: Expanding indications for ICDs will result in an increasing number of physicians implanting these devices.
METHODS: Using the 20% Part B Medicare files for 1999 through 2001, we identified new ICD implantations and the corresponding denominator files. We used Medicare Provider Analysis and Review hospital records and the appropriate International Classification of Diseases-9 diagnosis and procedure codes to define complications within 90 days. We defined physician volume categories by assigning one-quarter of the patients to each quartile. A logistic regression model was used to adjust outcomes for potential confounders.
RESULTS: Ninety-day mortality did not differ between patients who had their ICD implanted by physicians with the highest volume of implants and those who had their ICD implanted by physicians with the lowest volume of implants (6.2% vs. 5.9%; odds ratio [OR] 0.99; 95% confidence interval [CI] 0.75 to 1.30). Within 90 days, mechanical complications were significantly higher in the lowest volume quartile (OR 1.47; 95% CI 1.09 to 1.99) but were comparable for physicians who implanted at least 11 ICDs per year. The risk of ICD infection was significantly higher in patients who had their ICD implanted by physicians with the lowest volume of implants (OR 2.47; 95% CI 1.18 to 5.17).
CONCLUSIONS: We observed an association between a higher volume of ICD implants and a lower rate of mechanical complications and infections. This association suggests that ICD implantation should not be performed by physicians without regard to their procedural volume.
|
Abbreviations and Acronyms
| | CI = confidence interval | | ICD = implantable cardioverter-defibrillator | | LVEF = left ventricular ejection fraction | | MEDPAR = Medicare Provider Analysis and Review | | OR = odds ratio |
|
This article has been cited by other articles:
|
|
|
|
 
R. Margey, H. McCann, G. Blake, E. Keelan, J. Galvin, M. Lynch, N. Mahon, D. Sugrue, and J. O'Neill
Contemporary management of and outcomes from cardiac device related infections
Europace,
November 11, 2009;
(2009)
eup362v1.
[Abstract]
[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]
|
|
|
|
|
|
|
J. Coromilas
Physician Credentials and ICD Implantation: Certified "Electricians" Best Deal With Electrical Problems
JAMA,
April 22, 2009;
301(16):
1713 - 1714.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. N. Peterson, S. L. Daugherty, Y. Wang, H. J. Vidaillet, P. A. Heidenreich, J. P. Curtis, F. A. Masoudi, and on behalf of the National Cardiovascular Data Regi
Gender Differences in Procedure-Related Adverse Events in Patients Receiving Implantable Cardioverter-Defibrillator Therapy
Circulation,
March 3, 2009;
119(8):
1078 - 1084.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. F. Minnick and J. Needleman
Methodological Issues in Explaining Maternal Outcomes: Anesthesia Provider Characterizations and Resource Variation
West J Nurs Res,
November 1, 2008;
30(7):
801 - 816.
[Abstract]
[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]
|
|
|
|
|
|
|
I. Boutron, D. Moher, D. G. Altman, K. F. Schulz, P. Ravaud, and for the CONSORT Group
Extending the CONSORT Statement to Randomized Trials of Nonpharmacologic Treatment: Explanation and Elaboration
Ann Intern Med,
February 19, 2008;
148(4):
295 - 309.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A McAlister
Device therapy in heart failure
BMJ,
November 3, 2007;
335(7626):
895 - 896.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Ezekowitz, B. H. Rowe, D. M. Dryden, N. Hooton, B. Vandermeer, C. Spooner, and F. A. McAlister
Systematic Review: Implantable Cardioverter Defibrillators for Adults with Left Ventricular Systolic Dysfunction
Ann Intern Med,
August 21, 2007;
147(4):
251 - 262.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A. McAlister, J. Ezekowitz, N. Hooton, B. Vandermeer, C. Spooner, D. M. Dryden, R. L. Page, M. A. Hlatky, and B. H. Rowe
Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction: A Systematic Review
JAMA,
June 13, 2007;
297(22):
2502 - 2514.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Z. Uslan, M. R. Sohail, J. L. St. Sauver, P. A. Friedman, D. L. Hayes, S. M. Stoner, W. R. Wilson, J. M. Steckelberg, and L. M. Baddour
Permanent Pacemaker and Implantable Cardioverter Defibrillator Infection: A Population-Based Study
Arch Intern Med,
April 9, 2007;
167(7):
669 - 675.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Hlatky and D. B. Mark
The high cost of implantable defibrillators
Eur. Heart J.,
February 2, 2007;
28(4):
388 - 391.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. S. Chan, T. Chow, D. Kereiakes, E. J. Schloss, T. Waller, K. Eagle, R. A. Hayward, and S. Vijan
Effectiveness of implantable cardioverter-defibrillators in patients with ischemic heart disease and left ventricular dysfunction.
Arch Intern Med,
November 13, 2006;
166(20):
2228 - 2233.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. M. Krumholz and F. A. Masoudi
The Year in Epidemiology, Health Services Research, and Outcomes Research
J. Am. Coll. Cardiol.,
November 7, 2006;
48(9):
1886 - 1895.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Voigt, A. Shalaby, and S. Saba
Rising Rates of Cardiac Rhythm Management Device Infections in the United States: 1996 through 2003
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
590 - 591.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. R. Reynolds, D. J. Cohen, A. D. Kugelmass, P. P. Brown, E. R. Becker, S. D. Culler, and A. W. Simon
The Frequency and Incremental Cost of Major Complications Among Medicare Beneficiaries Receiving Implantable Cardioverter-Defibrillators
J. Am. Coll. Cardiol.,
June 20, 2006;
47(12):
2493 - 2497.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. B. Curtis
Experience Counts: Better Patient Outcomes With Higher Device Volumes
J. Am. Coll. Cardiol.,
October 18, 2005;
46(8):
1541 - 1542.
[Full Text]
[PDF]
|
|
|
|
