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    Original Investigation
    Cardiology
    October 18, 2019

    Analysis of Temporal Trends and Variation in the Use of Defibrillation Testing in Contemporary Practice

    Author Affiliations
    • 1Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
    • 2Cone Health Medical Group HeartCare, Greensboro, North Carolina
    • 3Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
    • 4Center of Outcomes and Research Evaluation, Yale-New Haven Health, New Haven, Connecticut
    • 5Department of Medicine, Denver Health Hospital, Denver, Colorado
    • 6Department of Medicine, Duke University School of Medicine, Durham, North Carolina
    • 7Department of Medicine, Rochester Hospital, Rochester, New York
    • 8Department of Medicine, Mayo Clinic, Rochester, Minnesota
    • 9Department of Medicine, University of California, San Diego, La Jolla
    • 10Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey
    JAMA Netw Open. 2019;2(10):e1913553. doi:10.1001/jamanetworkopen.2019.13553
    Key Points español 中文 (chinese)

    Question  What are contemporary trends, institutional variation, and patient and hospital characteristics associated with defibrillation testing among patients undergoing first-time implantable cardioverter-defibrillator implantation?

    Findings  In this cross-sectional study of 499 211 patients undergoing implantable cardioverter-defibrillator implantation, there was a significant decline in the use of defibrillation testing, yet there was a marked increase in institutional variation.

    Meaning  There is variability in the deadoption of defibrillation testing which is not based on patient characteristics and could reflect differences in individual or institutional practices.

    Abstract

    Importance  Defibrillation testing (DFT) is performed during implantable cardioverter-defibrillator (ICD) implantation to assess the capacity of the device to detect and terminate ventricular arrhythmias. However, DFT can result in complications and omission of its use has been shown to be safe.

    Objective  To describe temporal trends and variation in the use of DFT in contemporary practice in the United States.

    Design, Setting, and Participants  This multicenter cross-sectional study used data from the National Cardiovascular Data Registry ICD Registry. A total of 499 211 patients from 1794 different facilities undergoing first-time ICD implantation from April 2010 to December 2015 were included. Data analysis was performed from May 20, 2015, to August 15, 2019.

    Exposure  Defibrillation testing was assessed using the National Cardiovascular Data Registry ICD Registry.

    Main Outcomes and Measures  Defibrillation testing rates and median odds ratios (MORs) were assessed over time. The MOR represents the odds that a randomly selected patient receiving testing at a hospital with high testing rates would be tested compared with if he or she had received care at a hospital with low testing rates.

    Results  Of the 499 211 patients from 1794 different facilities included in this analysis, the mean (SD) age of the population was 65.5 (13.4) years and 356 681 patients (71.4%) were men. The use of DFT declined from 71.6% in the first calendar quarter of 2010 to 36.4% in the fourth quarter of 2015 (P < .001). Patients undergoing DFT were more likely than those without testing to have ischemic heart disease (170 569 [58.1%] vs 116 295 [56.6%]), ventricular tachycardia (91 500 [31.2%] vs 58 949 [28.7%]), and less advanced heart failure (New York Heart Association class I and II, 153 188 [52.2%] vs 91 215 [44.4%]) (P < .001 for all). The MOR for the use of defibrillation testing was 3.78 (95% CI, 3.54-4.03) in 2010, increasing to 6.05 (95% CI, 5.61-6.52) in 2015, indicating that by 2015 a randomly selected patient receiving testing at a hospital with high testing rates would have a 6-fold higher odds of being tested than if they had received care at a hospital with low testing rates.

    Conclusions and Relevance  Defibrillation testing at the time of ICD placement in the United States may have declined over time; however, institutional variation in its use appears to be marked and increased. This variability in the reduced use of defibrillation testing could reflect differences in individual or institutional cultures of practice.

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