Association of Physician Certification and Outcomes Among Patients Receiving an Implantable Cardioverter-Defibrillator
Why the study?
Does ICD implantation by nonelectrophysiologists increase procedural complications and reduce appropriate CRT-D use compared to electrophysiologists in patients receiving an ICD?
Population
111,293 patients receiving an implantable cardioverter-defibrillator between January 2006 and June 2007…
Comparison
ICD implantation performed by… vs ICD implantation performed by electrophysiologists
Design
Cohort
Follow-up
In-hospital
Authors
Discussion
Loading...
Member takes
Implication
May warrant caution with non-electrophysiologist ICD implantation; leaves open whether volume thresholds or targeted training can equalize outcomes.
Key Points
- This research aims to examine how the certification of the physician performing ICD implantation affects patient outcomes.
- Retrospective cohort study using data from the ICD Registry (2006-2007).
- Patients grouped by physician certification: electrophysiologists, nonelectrophysiologist cardiologists, thoracic surgeons, and others.
- Hierarchical logistic regression models analyzed procedural complications and device provision outcomes.
- Patients with ICDs from nonelectrophysiologists faced higher unadjusted complications (nonelectrophysiologists: 4.0%, thoracic surgeons: 5.8% vs. electrophysiologists: 3.5%, P < .001).
- Lower likelihood of receiving CRT-D in nonelectrophysiologists (75.8%) and thoracic surgeons (57.8%) compared to electrophysiologists (83.1%), P < .001.
- Adjusted analyses confirmed increased risk of complications and reduced CRT-D likelihood for non-electrophysiologist implants.
Structured PICO
Does ICD implantation by nonelectrophysiologists increase procedural complications and reduce appropriate CRT-D use compared to electrophysiologists in patients receiving an ICD?
P
Population
111,293 patients receiving an implantable cardioverter-defibrillator (ICD) between January 2006 and June 2007, including 35,841 patients who met criteria for CRT-D.
I
Intervention
ICD implantation performed by nonelectrophysiologists (nonelectrophysiologist cardiologists, thoracic surgeons, and other specialists)
C
Comparator
ICD implantation performed by electrophysiologists
O
Outcome
In-hospital procedural complication rates and the proportion of patients meeting criteria for a defibrillator with cardiac resynchronization therapy (CRT-D) who received that devicesafety
ICD implantation by nonelectrophysiologists is associated with a higher risk of procedural complications and a lower likelihood of receiving an indicated CRT-D device compared to implantation by electrophysiologists.
Cite This Study
Jeptha P. Curtis (2009) studied this question.