Key result
Non-monetary referral incentives linked to ~255% higher primary prevention ICD implantation in large-volume hospitals.
Why the study?
Primary prevention ICD therapy for ischemic cardiomyopathy is underused in Asian countries, and it was unknown whether clinical and hospital-level determinants of implantation differ by hospital implantation volume.
What clinical and hospital-level factors predict the use of primary prevention implantable cardioverter-defibrillators in patients with ischemic cardiomyopathy across different hospital volumes?
Observational (n=3,083)
non-blinded
Yes
What clinical and hospital-level factors predict the use of primary prevention implantable cardioverter-defibrillators in patients with ischemic cardiomyopathy across different hospital volumes?
Effect estimate: OR 3.55 (95% CI 2.07-6.10)
p-value: p=<0.001
Hospital-level factors influencing primary prevention ICD implantation differ significantly by hospital volume, indicating that tailored institutional strategies are necessary to improve guideline-directed device therapy in ischemic cardiomyopathy.
Non-monetary incentives may drive higher ICD implantation in large centers; this observational association leaves open questions of appropriateness and causality.
Primary prevention (PP) implantable cardioverter-defibrillator (ICD) therapy for ischemic cardiomyopathy (ICM) is underused in Asian countries, including South Korea. Both clinical and hospital factors may influence appropriate ICD use. We evaluated whether determinants of PP ICD implantation differ by hospital implantation volume. In this prospective, multicenter observational registry (blinded for review), patients eligible for PP ICD were enrolled. Factors associated with ICD implantation—clinical characteristics and hospital-level systems—were examined across 4 large-volume hospitals (≥ 15 implants during the study) and 12 small-volume hospitals (< 15). Multivariable logistic regression identified independent predictors. Among 3,083 ICM patients (2,403 men; median age 70 years), PP ICD implantation rates were 10.8% in large-volume and 5.7% in small-volume hospitals. Across groups, male sex and chronic kidney disease independently predicted ICD implantation. Regarding hospital factors, non-monetary incentives for referral were the sole independent predictor in large-volume centers (odds ratio [OR], 3.55; 95% confidence interval [CI], 2.07–6.10; P < 0.001). In small-volume centers, heart failure conferences (OR, 12.73; 95% CI, 1.72–94.37; P = 0.013), structured education systems (OR, 11.72; 95% CI, 2.45–56.12; P = 0.02), and pacemaker clinics (OR, 11.4; 95% CI, 2.24–58.39; P = 0.003) were independently associated with implantation. Clinical predictors of PP ICD use were consistent across hospital volumes, but hospital-level determinants differed. Referral incentives characterized large-volume centers, whereas conferences, education systems, and pacemaker clinics were key in small-volume centers. Tailored institutional strategies by hospital volume may help close the PP ICD underuse gap and improve evidence-based implementation. ClinicalTrials.gov Identifier: NCT03590925
No takes yet. Share an insight, caveat, or question.
A 2026 study conducted an observational in Ischemic cardiomyopathy (n=3,083). Non-monetary incentives for referral (large-volume hospitals) vs. No non-monetary incentives was evaluated on Primary prevention ICD implantation (OR 3.55, 95% CI 2.07-6.10, p=<0.001). Non-monetary referral incentives independently predicted primary prevention ICD implantation in large-volume hospitals (OR 3.55), whereas heart failure conferences and pacemaker clinics were key in small-volume centers.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: