Document Detail

Evidence of clinical practice heterogeneity in the use of implantable cardioverter-defibrillators in heart failure and post-myocardial infarction left ventricular dysfunction: Findings from IMPROVE HF.
MedLine Citation:
PMID:  19959119     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Clinical guidelines recommend implantable cardioverter-defibrillators (ICDs) for selected patients with chronic left ventricular dysfunction (LVD) to improve survival, yet ICD treatment rates for eligible patients with LVD or heart failure (HF) in cardiology practices remain poorly studied.
OBJECTIVE: This study sought to determine patient and practice characteristics associated with ICD use in the outpatient setting.
METHODS: IMPROVE HF (Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting), a prospective cohort study, is designed to characterize management of HF with reduced left ventricular ejection fraction (LVEF < or =35%). Baseline data were collected for 15,381 patients attending 167 outpatient cardiology practices located in the U.S.
RESULTS: By current guidelines, 7,221 patients met eligibility for ICD implantation (+/- cardiac resynchronization therapy [CRT]), of whom 3,659 (50.7%) received either ICD (63.8%) or CRT with defibrillator (36.2%). Individual practice conformity for guideline-recommended ICD use ranged from 0% to 100% (27.3% to 74.6% at the 10th and 90th percentiles, respectively). Adjusted analyses revealed lack of adherence for ICD use most notably with advancing age (odds ratio: 0.87; 95% confidence interval: 0.82 to 0.93 per 10 years), black race (odds ratio: 0.75; 95% confidence interval: 0.60 to 0.94), and lack of insurance (odds ratio: 0.45; 95% confidence interval: 0.26 to 0.78). Characteristics of increased adherence included male sex, ischemic disease, atrial fibrillation, and wider QRS. Practices in the Northeast U.S. were more likely to adhere to guidelines (P <.001), as were those with a dedicated HF clinic (P = .004) and electrophysiologists on staff (P <.001).
CONCLUSION: Although a number of patient and practice characteristics are associated with guideline-based ICD use, there is significant unexplained variation in the use of ICD therapy for sudden death prophylaxis across cardiology practices.
Mandeep R Mehra; Clyde W Yancy; Nancy M Albert; Anne B Curtis; Wendy Gattis Stough; Mihai Gheorghiade; J Thomas Heywood; Mark L McBride; Christopher M O'Connor; Dwight Reynolds; Mary Norine Walsh; Gregg C Fonarow
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-08-22
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  6     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-04     Completed Date:  2011-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1727-34     Citation Subset:  IM    
University of Maryland School of Medicine, Baltimore, Maryland, USA.
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MeSH Terms
Confidence Intervals
Defibrillators, Implantable*
Evidence-Based Medicine
Heart Failure / etiology,  mortality,  therapy*
Logistic Models
Middle Aged
Multivariate Analysis
Myocardial Infarction / complications*
Odds Ratio
Physician's Practice Patterns / statistics & numerical data*
Prospective Studies
Time Factors
United States
Ventricular Dysfunction, Left / etiology,  mortality,  therapy*
Ventricular Function, Left
Comment In:
Heart Rhythm. 2009 Dec;6(12):1735-6   [PMID:  19959120 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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