Variation in Use of Dual-Chamber Implantable Cardioverter-Defibrillators: Results From the National Cardiovascular Data Registry | Cardiology | JAMA Internal Medicine | JAMA Network
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Original Investigation
Apr 23, 2012

Variation in Use of Dual-Chamber Implantable Cardioverter-Defibrillators: Results From the National Cardiovascular Data Registry

Author Affiliations

Author Affiliations: Department of Medicine, University of Colorado Denver School of Medicine, Aurora (Drs Matlock, Peterson, Varosy, and Masoudi); Colorado Cardiovascular Outcomes Research Group, Denver (Drs Matlock, Peterson, Varosy, and Masoudi); Institute for Health Research, Kaiser Permanente Colorado, Denver (Drs Matlock, Peterson, and Masoudi); Department of Medicine, Denver Health Medical Center, Denver (Dr Peterson); Department of Internal Medicine, Yale University, New Haven, Connecticut (Mr Wang and Dr Curtis); Department of Medicine, Division of Cardiology, Beth Israel Deaconess Medical Center and the Boston VA Healthcare System, Boston, Massachusetts (Dr Reynolds); and The Medical Service, Section of Cardiology, Veterans Affairs Eastern Colorado Health Care System, Denver (Dr Varosy).

Arch Intern Med. 2012;172(8):634-641. doi:10.1001/archinternmed.2012.394

Background Among patients without an indication for a pacemaker, current evidence is inconclusive whether a dual-chamber implantable cardioverter-defibrillator (ICD) is superior to a single-chamber ICD. The current use of dual-chamber ICDs is not well characterized.

Methods We conducted a cross-sectional study exploring hospital-level variation in the use of dual-chamber ICDs across the United States. Patients receiving a primary prevention ICD from 2006 through 2009 without a documented indication for a pacemaker were included. Multivariate hierarchical logistic regression was used to explore patient, health care provider, and physician factors related to the use of a dual-chamber device.

Results Dual-chamber devices were implanted in 58% of the 87 115 patients without a pacing indication among 1293 hospitals, with hospital rates ranging from 0% in 33 centers to 100% in 109 centers. In multivariate analysis, geographic region was a strong independent predictor of dual-chamber device use, ranging from 36.4% in New England (reference region) to 66.4% in the Pacific region (odds ratio [OR], 5.25; 95% CI, 3.35-8.21). Hospital clustering was assessed using a median OR which was 3.96, meaning that 2 identical patients at different hospitals would have nearly a 4-fold difference in their chance of receiving a dual-chamber ICD.

Conclusions Use of dual-chamber ICDs for the primary prevention of sudden cardiac death among patients without an indication for permanent pacing varies markedly at the hospital level in the United States. This is a clear example of how practice can vary independent of patient factors.