TY - JOUR
T1 - Cardiac device implantation in the United States from 1997 through 2004
T2 - A population-based analysis
AU - Zhan, Chunliu
AU - Baine, William B.
AU - Sedrakyan, Artyom
AU - Steiner, Claudia
N1 - Funding Information:
Acknowledgments: The authors thank Zhengyi Fang, Social and Scientific Systems, Inc., for excellent computing support. We thank Parivash Nourjah, PhD, and Joyce Basu, PhD, the Agency for Healthcare Research and Quality, for useful comments. The authors would also like to acknowledge the statewide data organizations that participate in the HCUP Nationwide Inpatient Sample: California Office of Statewide Health Planning & Development; Colorado Health & Hospital Association; Connecticut - Chime, Inc.; Florida Agency for Health Care Administration; Georgia—GHA: An Association of Hospitals & Health Systems; Hawaii Health Information Corporation; Illinois Department of Public Health; Iowa Hospital Association; Kansas Hospital Association; Kentucky Department for Public Health; Maine Health Data Organization; Maryland Health Services Cost Review Commission; Massachusetts Division of Health Care Finance and Policy; Michigan Health and Hospital Association; Minnesota Hospital Association; Missouri Hospital Industry Data Institute; Nebraska Hospital Association; Nevada Department of Human Resources; New Jersey Department of Health & Senior Services; New York State Department of Health; North Carolina Department of Health and Human Services; Ohio Hospital Association; Oregon Association of Hospitals & Health Systems; Pennsylvania Health Care Cost Containment Council; Rhode Island Department of Health; South Carolina State Budget & Control Board; South Dakota Association of Healthcare Organizations; Tennessee Hospital Association; Texas Health Care Information Council; Utah Department of Health; Vermont Association of Hospitals and Health Systems; Virginia Health Information; Washington State Department of Health; West Virginia Health Care Authority; Wisconsin Department of Health & Family Services.
PY - 2008/1
Y1 - 2008/1
N2 - OBJECTIVE: Use of cardiac devices has been increasing rapidly along with concerns over their safety and effectiveness. This study used hospital administrative data to assess cardiac device implantations in the United States, selected perioperative outcomes, and associated patient and hospital characteristics. METHODS: We screened hospital discharge abstracts from the 1997-2004 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. Patients who underwent implantation of pacemaker (PM), automatic cardioverter/defibrillator (AICD), or cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) were identified using ICD-9-CM procedure codes. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed. MEASUREMENTS AND MAIN RESULTS: Approximately 67,000 AICDs and 178,000 PMs were implanted in 2004 in the United States, increasing 60% and 19%, respectively, since 1997. After FDA approval in 2001, CRT-D and CRT-P reached 33,000 and 7,000 units per year in the United States in 2004. About 70% of the patients were aged 65 years or older, and more than 75% of the patients had 1 or more comorbid diseases. There were substantial decreases in length of stay, but marked increases in charges, for example, the length of stay of AICD implantations halved (from 9.9 days in 1997 to 5.2 days in 2004), whereas charges nearly doubled (from $66,000 in 1997 to $117,000 in 2004). Rates of in-hospital mortality and complications fluctuated slightly during the period. Overall, adverse outcomes were associated with advanced age, comorbid conditions, and emergency admissions, and there was no consistent volume-outcome relationship across different outcome measures and patient groups. CONCLUSIONS: The numbers of cardiac device implantations in the United States steadily increased from 1997 to 2004, with substantial reductions in length of stay and increases in charges. Rates of in-hospital mortality and complications changed slightly over the years and were associated primarily with patient frailty.
AB - OBJECTIVE: Use of cardiac devices has been increasing rapidly along with concerns over their safety and effectiveness. This study used hospital administrative data to assess cardiac device implantations in the United States, selected perioperative outcomes, and associated patient and hospital characteristics. METHODS: We screened hospital discharge abstracts from the 1997-2004 Healthcare Cost and Utilization Project Nationwide Inpatient Samples. Patients who underwent implantation of pacemaker (PM), automatic cardioverter/defibrillator (AICD), or cardiac resynchronization therapy pacemaker (CRT-P) or defibrillator (CRT-D) were identified using ICD-9-CM procedure codes. Outcomes ascertainable from these data and associated hospital and patient characteristics were analyzed. MEASUREMENTS AND MAIN RESULTS: Approximately 67,000 AICDs and 178,000 PMs were implanted in 2004 in the United States, increasing 60% and 19%, respectively, since 1997. After FDA approval in 2001, CRT-D and CRT-P reached 33,000 and 7,000 units per year in the United States in 2004. About 70% of the patients were aged 65 years or older, and more than 75% of the patients had 1 or more comorbid diseases. There were substantial decreases in length of stay, but marked increases in charges, for example, the length of stay of AICD implantations halved (from 9.9 days in 1997 to 5.2 days in 2004), whereas charges nearly doubled (from $66,000 in 1997 to $117,000 in 2004). Rates of in-hospital mortality and complications fluctuated slightly during the period. Overall, adverse outcomes were associated with advanced age, comorbid conditions, and emergency admissions, and there was no consistent volume-outcome relationship across different outcome measures and patient groups. CONCLUSIONS: The numbers of cardiac device implantations in the United States steadily increased from 1997 to 2004, with substantial reductions in length of stay and increases in charges. Rates of in-hospital mortality and complications changed slightly over the years and were associated primarily with patient frailty.
KW - Administrative data
KW - Cardiac resynchronization therapy
KW - ICD-9-CM
KW - Implantable cardioverter-defibrillator
KW - Pacemaker
UR - http://www.scopus.com/inward/record.url?scp=37349020985&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=37349020985&partnerID=8YFLogxK
U2 - 10.1007/s11606-007-0392-0
DO - 10.1007/s11606-007-0392-0
M3 - Article
C2 - 18095038
AN - SCOPUS:37349020985
VL - 23
SP - 13
EP - 19
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 1 SUPPL.
ER -