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Temporal Trends in Quality of Care among ICD Recipients:Insights from the NCDR(R).
MedLine Citation:
PMID:  24192798     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The ICD Registry™ was established in 2006 in part to measure quality of care in patients undergoing ICD implantation; however, whether outcomes have improved since initiation of the registry is unknown. Our objective was to examine changes over time in three quality metrics available from the registry.
METHODS AND RESULTS: We performed an observational study of 367,153 patients receiving new ICD implants from 4/2006-3/2010. Three quality metrics were selected: adverse events (in-hospital complications or mortality), optimal medical therapy (OMT), and cardiac resynchronization therapy (CRT). OMT was defined as prescription of beta blocker and either ACE inhibitor or ARB in eligible patients. CRT eligibility was determined by QRS ≥120ms, LVEF ≤35%, and NYHA class III/IV. Observation periods were divided into four 12-month intervals. We analyzed changes over time, and used hierarchical logistic regression to adjust for potential confounders. Adverse events decreased over time (3.7% to 2.8%, P<0.001). Among eligible patients, rates of OMT and CRT increased over time (OMT: 69.0% to 74.3%, P <0.001; CRT: 80.5% to 84.2%, P<0.001). After adjustment for potential confounders, patients were significantly less likely to experience adverse events in Year 4 compared with Year 1 (OR 0.75, 95% CI 0.71-0.79), and significantly more likely to receive OMT (OR 1.29, 95% CI 1.26-1.32) and CRT (OR 1.42, 95% CI 1.35-1.49).
CONCLUSIONS: Since initiation of the ICD Registry, adverse events are decreasing, and rates of OMT and CRT among eligible patients are increasing, although there is still significant room for improvement.
Authors:
John A Dodson; Rachel Lampert; Yongfei Wang; Stephen C Hammill; Paul Varosy; Jeptha P Curtis
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-5
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Brigham and Women's Hospital, Boston, MA.
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