16 Aug Implantable Cardioverter Defibrillators and Reduction in Mortality, Readmissions
MedicalResearch.com Interview with:
Ryan T. Borne MD
University of Colorado Anschutz Medical Campus
Division of Cardiology
Aurora, CO 80045
Medical Research: What are the main findings of the study?
Dr. Borne: Using the NCDR ICD Registry, we identified Medicare beneficiaries aged 65 years and older with low left ventricular ejection fraction (≤ 35%) who underwent primary prevention implantable cardioverter defibrillator implantation, including those receiving cardiac resynchronization therapy with defibrillator, between 2006 and 2010 who could be matched to Medicare claims. We found that while there were modest changes in the patient characteristics undergoing ICD implantation, there were significant improvements over time in mid-term outcomes including 6-month mortality, re-hospitalization, and device-related complications.
Medical Research: Were any of the findings unexpected?
Dr. Borne: Yes. There was heterogeneity in outcomes among patients according to device type, including a higher mortality over time among patients receiving single chamber ICDs. The reasons for this trend are unclear and deserve further investigation.
Medical Research: What should clinicians and patients take away from your report?
Dr. Borne: I think the important points of this study are three-fold.
- First, the observed characteristics of patients undergoing primary prevention ICD implantation changed little from 2006 to 2010, demonstrating that there does not appear to be greater permissiveness in the use of this therapy over time.
- Second, 6-month mortality and re-hospitalization improved significantly, in addition to lower complication rates despite use of more complex devices including CRT-D.
- Finally, registries such as the NCDR are important for providing ways to make these significant observations.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Borne: The observation of higher mortality among patients undergoing single chamber ICD implantation over time deserves further investigation.
Temporal Trends in Patient Characteristics and Outcomes Among Medicare Beneficiaries Undergoing Primary Prevention Implantable Cardioverter-Defibrillator Placement in the United States, 2006-2010: Results from the NCDR ICD Registry
Circulation. 2014;CIRCULATIONAHA.114.008653published online before print August 5 2014, doi:10.1161/CIRCULATIONAHA.114.008653