January 25, 2017JAMA CardiologyOpen Access

Use of Cardiac Resynchronization Therapy Among Eligible Patients Receiving an Implantable Cardioverter Defibrillator

View Full Paper

Ask AI

Bookmark

Why the study?

What are the patient, clinician, and hospital characteristics associated with use of cardiac resynchronization therapy defibrillators (CRT-Ds) and what is the extent of hospital variation in CRT-D use?

Population

71,662 adult patients at 1,428 NCDR ICD Registry-participating hospitals who met class I or IIa guideline…

Comparison

Implantation of a cardiac resynchronization… vs Implantation of an implantable cardioverter…

Design

Cohort

Authors

LMLucas MarzecKaiser Permanente PPPamela N. PetersonDenver Health Medical Center HBHaikun BaoElectrophysiology

Discussion

Member takes

Implication

Racial and insurance disparities in CRT-D use persist with wide hospital variation; leaves open whether targeted interventions can improve equitable access.

Structured PICO

Population

71,662 adult patients at 1,428 NCDR ICD Registry-participating hospitals who met class I or IIa guideline recommendations for cardiac resynchronization therapy (CRT) and underwent primary prevention ICD or CRT-D implantation between April 1, 2010, and June 30, 2014.

Intervention

Implantation of a cardiac resynchronization therapy defibrillator (CRT-D)

Comparator

Implantation of an implantable cardioverter defibrillator (ICD) alone

Outcome

Implantation of an ICD alone or CRT-D device

While nearly 90% of eligible patients receive CRT-D, significant disparities exist based on race, insurance type, and hospital, highlighting opportunities for quality improvement in guideline-directed device therapy.

Limitations

The NCDR ICD Registry does not contain data on patients who were eligible for either ICD or CRT-D implantation but did not receive any device.
Could not account for unmeasured variables (including the rate of optimal medical therapy or patient preference) that may have influenced device choice.
Study may be subject to residual confounding, such as the influence of socioeconomic status on the association between black race and CRT-D implantation.
Unable to account for cases in which clinical judgment regarding CRT use may have appropriately conflicted with guideline recommendations.

Cite This Study

Marzec et al. (2017) studied this question.

synapsesocial.com/papers/6a0fefe4d13714ec96fedb21 https://doi.org/10.1001/jamacardio.2016.5388

Topics

Cardiac device therapy HFrEF treatment Persistent AF management Atrial fibrillation Heart failure

View Full Paper

Ask AI

Bookmark

Implication

Racial and insurance disparities in CRT-D use persist with wide hospital variation; leaves open whether targeted interventions can improve equitable access.

Use of Cardiac Resynchronization Therapy Among Eligible Patients Receiving an Implantable Cardioverter Defibrillator

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Topics

Use of Cardiac Resynchronization Therapy Among Eligible Patients Receiving an Implantable Cardioverter Defibrillator

Discussion

Member takes

Implication

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider