TY - JOUR
T1 - Implantable Cardioverter Defibrillator Utilization and Mortality Among Patients ≥65 Years of Age With a Low Ejection Fraction After Coronary Revascularization
AU - Goldstein, Sarah A.
AU - Li, Shuang
AU - Lu, Di
AU - Matsouaka, Roland A.
AU - Rymer, Jennifer
AU - Fonarow, Gregg C.
AU - de Lemos, James A.
AU - Peterson, Eric
AU - Pokorney, Sean D.
AU - Wang, Tracy
AU - Al-Khatib, Sana M.
N1 - Funding Information:
Sources of Funding: This research was supported by the American College of Cardiology's National Cardiovascular Data Registry (NCDR). The views expressed in this manuscript represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies.
Funding Information:
Sources of Funding: This research was supported by the American College of Cardiology's National Cardiovascular Data Registry (NCDR). The views expressed in this manuscript represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies.
Funding Information:
Li, Lu, Matsouka, de Lemos, Peterson, and Al-Khatib have no relevant conflicts of interest to disclose. Goldstein is supported by the National Institutes of Health training grant T-32-HL069749-15. Rymer receives research support from Boston Scientific and Abbott Pharmaceuticals. Fonarow consults for Abbott, Amgen, AstraZeneca, Bayer, Edwards, Janssen Pharmaceuticals, Medtronic, Merck and Novartis. Pokorney receives research support from Bristol-Myers Squibb, Pfizer, Janssen Pharmaceuticals, Gilead, Boston Scientific and the US Food and Drug Administration, and consults for Bristol Myers Squibb, Pfizer, Janssen Pharmaceuticals, Boston Scientific, Medtronic and ZOLL. Wang receives research support from Abbott, AstraZeneca, Bristol Myers Squibb, Boston Scientific, Cryolife, Chiesi, Merck, Portola and Regeneron and consults for AstraZeneca, Bristol Myers Squibb and Cryolife.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2021/1/1
Y1 - 2021/1/1
N2 - The purpose of this analysis was to assess implantable cardioverter-defibrillator (ICD) utilization and its association with mortality among patients ≥65 years of age after coronary revascularization. Patients in the National Cardiovascular Database Registry Chest Pain-Myocardial Infarction (MI) Registry who presented with MI from January 2, 2009 to December 31, 2016, had a left ventricular ejection fraction ≤35% and underwent in-hospital revascularization (10,014 percutaneous coronary intervention (PCI) and 1,647 coronary artery bypass grafting (CABG)) were linked with Medicare claims to determine rates of 1-year ICD implantation. The association between ICD implantation and 2-year mortality was assessed. Of 11,661 included patients, an ICD was implanted in 1,234 (10.6%) within 1 year of revascularization (1,063 (10.6%) PCI and 171 (10.4%) CABG). Among PCI-treated patients, in-hospital ventricular arrhythmia (adjusted hazard ratio [aHR] 1.60, 95% confidence interval [CI] 1.34 to 1.92), 2-week cardiology follow-up (aHR 1.48, 95% CI 1.29 to 1.70), readmission for heart failure (aHR 3.21, 95% CI 2.73 to 3.79), and readmission for MI (aHR 2.18, 95% CI 1.66 to 2.85) were positively associated with ICD implantation. Among CABG-treated patients, in-hospital ventricular arrhythmia (aHR 2.33, 95% CI 1.39 to 3.91), and heart failure readmission (aHR 3.14, 95% CI 1.96 to 5.04) were positively associated with ICD implantation. Women were less likely to receive an ICD, regardless of the revascularization strategy. ICD implantation was associated with lower 2-year all-cause mortality (aHR 0.74, 95% CI 0.63 to 0.86). In conclusion, only 1 in 10 Medicare patients with low ejection fraction received an ICD within 1 year after revascularization. Contact with the healthcare system after discharge was associated with higher likelihood of ICD implantation. ICD implantation was associated with lower mortality following revascularization for MI.
AB - The purpose of this analysis was to assess implantable cardioverter-defibrillator (ICD) utilization and its association with mortality among patients ≥65 years of age after coronary revascularization. Patients in the National Cardiovascular Database Registry Chest Pain-Myocardial Infarction (MI) Registry who presented with MI from January 2, 2009 to December 31, 2016, had a left ventricular ejection fraction ≤35% and underwent in-hospital revascularization (10,014 percutaneous coronary intervention (PCI) and 1,647 coronary artery bypass grafting (CABG)) were linked with Medicare claims to determine rates of 1-year ICD implantation. The association between ICD implantation and 2-year mortality was assessed. Of 11,661 included patients, an ICD was implanted in 1,234 (10.6%) within 1 year of revascularization (1,063 (10.6%) PCI and 171 (10.4%) CABG). Among PCI-treated patients, in-hospital ventricular arrhythmia (adjusted hazard ratio [aHR] 1.60, 95% confidence interval [CI] 1.34 to 1.92), 2-week cardiology follow-up (aHR 1.48, 95% CI 1.29 to 1.70), readmission for heart failure (aHR 3.21, 95% CI 2.73 to 3.79), and readmission for MI (aHR 2.18, 95% CI 1.66 to 2.85) were positively associated with ICD implantation. Among CABG-treated patients, in-hospital ventricular arrhythmia (aHR 2.33, 95% CI 1.39 to 3.91), and heart failure readmission (aHR 3.14, 95% CI 1.96 to 5.04) were positively associated with ICD implantation. Women were less likely to receive an ICD, regardless of the revascularization strategy. ICD implantation was associated with lower 2-year all-cause mortality (aHR 0.74, 95% CI 0.63 to 0.86). In conclusion, only 1 in 10 Medicare patients with low ejection fraction received an ICD within 1 year after revascularization. Contact with the healthcare system after discharge was associated with higher likelihood of ICD implantation. ICD implantation was associated with lower mortality following revascularization for MI.
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U2 - 10.1016/j.amjcard.2020.09.056
DO - 10.1016/j.amjcard.2020.09.056
M3 - Article
C2 - 33068540
AN - SCOPUS:85094577008
SN - 0002-9149
VL - 138
SP - 26
EP - 32
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -