Geographic variation in implantable cardioverter-defibrillator use and heart failure survival

Andrew J. Epstein, Daniel E. Polsky, Feifei Yang, Lin Yang, Peter W. Groeneveld

Research output: Contribution to journalArticle

Abstract

Background: Implantable cardioverter-defibrillators and cardiac resynchronization therapy-defibrillators (ICD/CRT-Ds) are evidence-based preventative treatments for many patients with heart failure (HF), yet large numbers of eligible patients remain untreated. It is uncertain if localities with more frequent ICD/CRT-D use have had better rates of HF survival. Objectives: To determine if US Hospital Referral Regions (HRRs) with larger increases in the rate of ICD/CRT-D utilization during 2002 to 2007 also had commensurate increases in HF survival. Research Design: Retrospective cohort. Participants: Medicare beneficiaries age 66 to 80 nonelectively hospitalized for HF from 2002 to 2007. Measures: Each HRR's annual ICD/CRT-D rate was estimated from the cohort's Medicare procedure claims. Survival duration was determined from Medicare mortality records. HRR-year-level panel regression models were estimated to assess whether an HRR's ICD/CRT-D rate predicted HF survival, adjusting for baseline differences in survival across HRRs and secular trends. Results: A total of 883,002 HF patients were propensity-score matched within HRR across 2002 to 2007. Across HRRs, growth in ICD/CRT-D use among such patients varied from 1 to 12 percentage points. Regression models indicated that a 1 percentage point increase in an HRR's ICD/CRT-D utilization among hospitalized HF patients was associated with an increase in 1-year survival of 0.12% [95% confidence interval (CI), 0.03%-0.21%, P=0.009] and with a 0.26% increase in HF survival at 2 years (95% CI, 0.14%-0.37%, P<0.001). Conclusions: Localities with greater increases in ICD/CRT-D utilization from 2002 to 2007 also had greater improvements in HF survival. Areas with persistently low ICD/CRT-D use may be good targets for programs designed to increase the evidence-based use of defibrillators.

Original languageEnglish (US)
Pages (from-to)10-17
Number of pages8
JournalMedical care
Volume50
Issue number1
DOIs
StatePublished - Jan 1 2012
Externally publishedYes

Fingerprint

Implantable Defibrillators
Heart Failure
Survival
Referral and Consultation
Medicare
Defibrillators
Confidence Intervals
Propensity Score
Cardiac Resynchronization Therapy
Research Design
Mortality

Keywords

  • cardiovascular disease
  • congestive heart failure
  • health care technology
  • mortality
  • utilization

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Geographic variation in implantable cardioverter-defibrillator use and heart failure survival. / Epstein, Andrew J.; Polsky, Daniel E.; Yang, Feifei; Yang, Lin; Groeneveld, Peter W.

In: Medical care, Vol. 50, No. 1, 01.01.2012, p. 10-17.

Research output: Contribution to journalArticle

Epstein, Andrew J. ; Polsky, Daniel E. ; Yang, Feifei ; Yang, Lin ; Groeneveld, Peter W. / Geographic variation in implantable cardioverter-defibrillator use and heart failure survival. In: Medical care. 2012 ; Vol. 50, No. 1. pp. 10-17.
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AB - Background: Implantable cardioverter-defibrillators and cardiac resynchronization therapy-defibrillators (ICD/CRT-Ds) are evidence-based preventative treatments for many patients with heart failure (HF), yet large numbers of eligible patients remain untreated. It is uncertain if localities with more frequent ICD/CRT-D use have had better rates of HF survival. Objectives: To determine if US Hospital Referral Regions (HRRs) with larger increases in the rate of ICD/CRT-D utilization during 2002 to 2007 also had commensurate increases in HF survival. Research Design: Retrospective cohort. Participants: Medicare beneficiaries age 66 to 80 nonelectively hospitalized for HF from 2002 to 2007. Measures: Each HRR's annual ICD/CRT-D rate was estimated from the cohort's Medicare procedure claims. Survival duration was determined from Medicare mortality records. HRR-year-level panel regression models were estimated to assess whether an HRR's ICD/CRT-D rate predicted HF survival, adjusting for baseline differences in survival across HRRs and secular trends. Results: A total of 883,002 HF patients were propensity-score matched within HRR across 2002 to 2007. Across HRRs, growth in ICD/CRT-D use among such patients varied from 1 to 12 percentage points. Regression models indicated that a 1 percentage point increase in an HRR's ICD/CRT-D utilization among hospitalized HF patients was associated with an increase in 1-year survival of 0.12% [95% confidence interval (CI), 0.03%-0.21%, P=0.009] and with a 0.26% increase in HF survival at 2 years (95% CI, 0.14%-0.37%, P<0.001). Conclusions: Localities with greater increases in ICD/CRT-D utilization from 2002 to 2007 also had greater improvements in HF survival. Areas with persistently low ICD/CRT-D use may be good targets for programs designed to increase the evidence-based use of defibrillators.

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